Monday, February 7, 2011

Athletes And Statins

Tom Naughton writes on statins.

Athletes And Statins
from Fat Head by Tom Naughton
I spent a good chunk of today dealing with computer issues — both PC and Mac, so while I agree that Macs are generally more stable, the belief that they’re trouble-free has more to do with good advertising than with reality. Anyway, because so much of my day was eaten up, this will be a brief post.

It was yet another bang-up Super Bowl. I love it when the game is in doubt until the very end … although as a Bears fan, I didn’t mind seeing them blow away the Patriots back in 1986. I like the pomp of the Super Bowl, the hype, the buzz, the commercials, the halftime shows, the whole experience. And of course I enjoy the game itself, watching athletes at the very top of their games giving it everything they’ve got.

As I was watching recaps of the game today, it occurred to me that I recently downloaded an article from the British Journal of Clinical Pharmacology on how statins affect professional athletes. I think the title pretty much says it all:

Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems

The paper’s authors are from Austria and examined case histories of Austrian professional athletes who attempted to go on statin therapy to treat genetically high cholesterol. Out of 22 athletes, only three were able to tolerate the first statin they were prescribed. Three more were able to eventually tolerate a statin other than the first one prescribed. The remaining 16 — 72% of the total — ended up refusing statin therapy. You can probably guess what it was about statins that most of the athletes couldn’t tolerate: muscle pain and muscle weakness.

The authors noted that in reviews of multiple clinical trials, muscle problems were reported in 5% of those taking statins on average. They also noted that in a study of statin-takers who engage in strenuous exercise, muscle problems affected closer to 25%. Now in this study we’ve got 72% of professional athletes (in an admittedly small sample size) saying they can’t tolerate statins because of muscle problems.

So here’s what I think is happening: statins are probably causing at least some degree of muscle weakness in a large percentage of those taking them. But not everyone whose muscles are weakened will feel pain or even notice the damage, as Dr. Duane Graveline wrote in an article on his web site:

In the Journal of Pathology 210: 94-102, 2006, Draeger A and others of the University of Bern, Switzerland report: Statin therapy induces ultrastructural damage in skeletal muscle in patients without myalgia.

Draeger’s group did skeletal muscle biopsies from statin treated and non-statin treated patients and examined them using electron microscopy and biochemical approaches. They reported clear evidence of skeletal muscle damage in statin treated patients despite their being asymptomatic. Although the degree of overall damage was minimal, it was the characteristic pattern of damage, including rupture of critical structures that caught the attention of the investigators.

The more you depend on your muscles, the more likely you are to notice minor damage. Most people who sit for a living and aren’t dedicated to exercising could probably become a bit weaker without ever noticing, which would explain why only 5% percent of all statin-takers report muscle problems. But if you limit the study to people who engage in strenuous exercise — and are therefore more likely to track their speed or strength — the number goes up to 25%. Limit the study to professional athletes, and now you’re looking at 72% reporting muscle problems.

For professional athletes, an almost-imperceptible loss of muscular ability can mean the difference between winning and losing. Think about some of the key plays in last night’s Super Bowl, if you watched. A wide receiver catches a pass because he managed to outrun a cornerback by an extra six inches over the course of 30 yards. A linebacker misses a tackle because the tailback was a split-second quicker. “It’s a game of inches” is a cliché in sports, but it’s a cliché because it’s true. The professional athlete who loses a tiny fraction of his speed or strength can find himself sitting on the bench or looking for another job.

So I don’t think professional athletes are especially vulnerable to statin-induced muscle damage. I think they’re just far more likely to notice that damage is being done.

Check out his web site for the latest here.

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