Hypercholesterolemia Statins

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Hypercholesterolemia contributes significantly to overall cardiovascular morbidity and mortality. Statins are the number one class of anticholesterol medications. They are well known for side effects of gastrointestinal disturbance, headache, and rash. For athletes, myalgias and, rarely, rhabdomyolysis are possible complications of significant import. Baseline creatine kinase levels prior to onset of statin therapy may be useful in case these complications arise.15 Most changes in creatine kinase levels with statin use and/or exercise are asymptomatic. Rhabdomyolysis appears to be more likely to occur due to a combination of statin use, exercise, and another medication metabolized by cytochrome P-450.16 In an experimental trial of over-the-counter use of statins, 17% of users experienced a drug-related adverse event, and 12% of users discontinued statin therapy due to an adverse event.17 Most studies of statins and exercise involve patients with some form of vascular disease. In patients with claudication due to peripheral artery disease, statin use improved total treadmill time and walking distance.18,19 In patients with significant coronary artery disease, statin use significantly decreased myocardial ischemia due to exercise without affecting peak heart rate, systolic blood pressure, or diastolic blood pressure.20

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