Combining statin treatment with better fitness improves survival in people with dyslipidaemia

Taking statins or being even modestly physically fit markedly improves survival in people with dyslipidaemia (abnormal levels of harmful blood fats/cholesterol), according to new research published Online First in The Lancet. But combining statin treatment with better fitness may do more to ward off death than either intervention alone.

Most strikingly, the study found that even people with dyslipidaemia not taking statins, but who were highly fit, were roughly half as likely to die from any cause during the median 10-year follow up than those taking statins, but who were unfit.

“The fitness necessary to attain protection that is much the same or greater than that achieved by statin treatment in unfit individuals is moderate and feasible for many middle-aged and older adults through moderate intensity physical activity such as walking, gardening, and gym classes”, explains Peter Kokkinos from the Veterans Affairs Medical Center, Washington DC, who led the research.

In the USA, approximately 71 million adults (33.5%) have elevated LDL-cholesterol according to Center for Disease Control. Dyslipidaemia is a key contributor to the incidence of coronary heart disease.

Kokkinos and colleagues assessed the records of over 10 000 veterans (9700 men and 343 women) with dyslipidaemia from Veterans Affairs hospitals in Washington DC and Palo Alto, California, USA.

All participants were given a standard exercise tolerance test between the years 1986 and 2011 to determine their exercise capacity. Using a measure of the peak metabolic rate (MET) achieved while exercising, the researchers classified fitness level as least, moderate, fit, or high. Patients were then divided into two groups (those treated with statins and not treated with statins) within each fitness category.

The researchers found that death rates were lowest for those who were taking statins and were physically fit. The higher the level of fitness the lower the risk of dying during the median follow-up period of 10 years. The fittest participants, regardless of whether they were taking statins, had a significantly (60–70%) lower risk of death.

The difference in death risk could not be explained by factors such as age, body mass, ethnicity, sex, history of cardiovascular disease, risk factors for cardiovascular disease, and medications.

In light of the findings Kokkinos recommends, “Individuals with dyslipidaemia should improve their fitness to at least a moderate level. Treatment with statins is important, but better fitness improves survival significantly and is a valuable additional treatment or an alternative when statins cannot be taken.”

Writing in a linked Comment, Pedro Hallal from the Federal University of Pelotas in Brazil and I-Min Lee from Harvard Medical School in the USA say that the prescription of physical activity should be placed on a par with drug prescription, pointing out that, “The cost of becoming physically active is lower than that of buying drugs and moderate intensity physical activity has fewer side-effects.”