Possible mechanisms for statin myopathy and its relationship to physical exercise

Statins are a very effective and well-tolerated class of lipid-lowering agents that have been shown to reduce the risk of first and recurrent cardiovascular events. Their major adverse side effect is that they can produce a variety of skeletal muscle complaints ranging from mild myalgia to life-threatening rhabdomyolysis. Exercise can also injure skeletal muscle, and many cases of presumed statin myopathy are associated with physical activity. This literature review summarizes current concepts of statin myopathy and discuses how physical exercise may both exacerbate symptoms and possibly assist in defining the mechanisms of statin-associated muscle injury. The results suggest that exercise may cause many of the creatine kinase (CK) elevations during statin therapy and also exacerbate these CK increases. Physicians should also consider, based on circumstantial evidence, withholding statins prior to prolonged vigorous exercise to avoid clinically important rhabdomyolysis.

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