This is an ideal combination for those with high LDL-C levels that do not respond to lifestyle changes alone or for those who have not received or are unlikely to follow advice about making lifestyle changes.
For some, if not many, patients it may be easier to take one or two tablets each day than to find the time and determination to exercise regularly. Despite this, the attending medical practitioner should strongly recommend combining statins with lifestyle changes, including exercise.
In an observational study, both statins and exercise individually reduced the adverse outcomes of CVD. Their combined effects were additive (Table 3). In the least physically fit, no statin group, baseline total cholesterol was 6.0 mmol/l, with baseline LDL-C being 4 mmol/l.
After statin treatment, total cholesterol was 4.1 mmol/l, and LDL-C was 2.6 mmol/l (p<0.0001).
Before intense exercise, lipids levels were similar. After intense exercise training, values were: total cholesterol 5.1 mmol/l, with LDL-C being 3.6 mmol/l.
The combination of high fitness (for definition, refer to Lee and Paffenbarger[45]) and statin treatment in patients yielded a substantial reduction in mortality risk than in those who were least fit and either taking statin or no statin (HR 0.30; p<0.0001).
The major unresolved problem is that either exercise or statins can singly cause muscular symptoms with an elevation of serum CK.[35] There is, as yet, no clearly defined outcomes-based policy to deal with such symptoms.
A reasonable practical approach is to assess the CK level, and if elevated, to reduce either the statin dose or the intensity of exercise to brisk walking (Fig. 4).[44,45]
Conclusion
Both lifestyle changes and statin therapy and their combination have well-defined positive roles in the management of the patient who needs advice on cardiovascular health.
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