Conclusions Regarding Statin Use in Exercising Adults
| Conclusion | SORT Categorization | References |
|---|---|---|
| Myopathy is a significant adverse outcome of exposure to statins. | A | 40 |
| Addition of statins in exercising adults significantly increases myopathy risk. | B | 18 |
| Addition of statins may present special risk for reduction in physical activity in: | ||
| Very high levels of activity | C | 43 |
| The elderly | B | 40, 44, 49 |
| High-dose statin therapy | B | 18 |
| Statins added to exercise can provide additional protection against cardiovascular events and mortality. | B | 21 |
| A stable level of physical activity should be established before starting a statin. | B | 58, 59 |
| If statins are used, low doses can provide similar protection to high doses in primary prevention. | B | 60, 61 |
| Fluvastatin may be the least myotoxic of the statins and the least likely to cause myalgia with exercise. | B | 18, 35 |
| Ezetimibe and colesevelam do not cause myopathy and may be useful in combination or when added to a statin. | B | 82, 86 |
| Other measures to improve statin tolerance may be useful, but evidence is of low quality and confounded by a considerable nocebo effect. | C | 53, 62, 63, 69, 70 |
| If a choice needs to be made between drug and exercise interventions, continued exercise is the better option. | B | 21 |
SORT, Strength of Recommendation Taxonomy.22