Rx for Exercise

The best cure for cardiovascular disease (CVD) is prevention. Controlling the risk factors that contribute to the development of CVD, such as smoking, high blood pressure and high cholesterol, can dramatically reduce an individual’s risk of future cardiac events. Although a healthy diet and adequate physical activity are the established first line of defense against developing CVD, the fact remains that many Americans are prescribed medications to further reduce their CVD risk.
Statin  The statin drugs (such as Lipitor and Crestor) are the most effective drugs for reducing low-density lipoprotein cholesterol (LDL-C), or “bad cholesterol.” These drugs are extremely effective at reducing cardiovascular disease and as a result are presently the most widely prescribed drugs in the United States and the world.
A very interesting study in the journal Lancet recently examined the interactive effects of statins and fitness level on mortality risk. Using a database of over 10,000 veterans in the Veteran’s Affairs Medical system, authors classified participants in one of four fitness categories ranging from highly fit to least fit. Researchers also noted whether participants were taking statins or not taking statins. Both high fitness and statin drug use decreased mortality risk, which is to be expected. However, individuals who were both highly fit AND taking a statin had the lowest mortality risk of any study participants. Conversely, the group at highest risk for premature mortality was the group not on statins and with low exercise capacity.
So why is this study so intriguing? Well, for the highest fit individuals in the study, the protection against mortality garnered from being very fit was GREATER than the mortality benefit observed from less fit individuals who were taking statins. Therefore, this study reinforces that physical activity in and of itself is an extremely effective means to prevent premature mortality. In fact, in the approximately 10% of patients who cannot tolerate statin drugs due to muscle side effects such as cramping and muscle pain, improved fitness may be an alternative treatment to statin therapy. At the very least, physicians should regard prescribing and encouraging routine exercise as critically important to health and CVD prevention as a statin prescription. And, bottom line, patients should recognize that getting a pharmaceutical prescription does not mitigate the need for daily physical activity to prevent mortality.

Reference: Kokkinos PF, Faselis C, Myers J, Panagiotakos D, Doumas M. Interactive effects of fitness and statin treatment on mortality risk in veterans with dyslipidaemia: a cohort study. Lancet. 2013 Feb 2;381(9864):394-9.


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