Perspective:

Statins (or HMG-CoA reductase inhibitors) are very effective in decreasing mortality in people with cardiovascular disease or those at high risk of developing heart disease. Some recent studies have raised concerns with use of statins including risk of developing diabetes, and more recently, that it may attenuate some of the fitness benefits of exercise. A recent pilot study of 37 patients reported that simvastatin attenuates increases in cardiorespiratory fitness and skeletal muscle mitochondrial content when combined with exercise training in overweight or obese patients at risk of the metabolic syndrome, and has garnered national media attention. However, another recent cross-sectional analysis of over 10,000 patients indicates that both statin use and increased physical fitness are separately associated with reduced mortality, but that there is an additive benefit of the combination such that physically active patients treated with statins demonstrate the lowest risk for premature mortality. While legitimate questions have been raised regarding potential interactions between exercise benefits and statin use, and additional research is indicated, these preliminary findings should not persuade clinicians to deprive patients with appropriate indications for statin use of this highly effective therapy.