Statins are commonly prescribed for management of dyslipidaemia and cardiovascular disease. Increased fitness is also associated with low mortality and is recommended as an essential part of promoting health. However, little information exists about the combined effects of fitness and statin treatment on all-cause mortality.
Researchers have assessed the combined effects of statin treatment and fitness on all-cause mortality risk.
In this prospective cohort study, researchers have included dyslipidaemic veterans from Veterans Affairs Medical Centers in Palo Alto, CA, and Washington DC, USA, who had had an exercise tolerance test between 1986, and 2011.
Participants were assigned to one of four fitness categories based on peak metabolic equivalents ( MET ) achieved during exercise test and eight categories based on fitness status and statin treatment.
The primary endpoint was all-cause mortality adjusted for age, body-mass index, ethnic origin, sex, history of cardiovascular disease, cardiovascular drugs, and cardiovascular risk factors.
Researchers have assessed mortality from Veteran's Affairs’ records on Dec 31, 2011.
10043 participants ( mean age 58•8 years ) were assessed.
During a median follow-up of 10.0 years, 2318 patients died, with an average yearly mortality rate of 22 deaths per 1000 person-years.
Mortality risk was 18.5% ( 935/5046 ) in people taking statins versus 27.7% ( 1386/4997 ) in those not taking statins ( p less than 0.0001 ).
In patients who took statins, mortality risk decreased as fitness increased; for highly fit individuals ( greater than 9 MET; n=694 ), the hazard ratio ( HR ) was 0.30 ( p less than 0.0001 ) compared with least fit ( less than or equal to 5 METs ) patients ( HR=1; n=1060 ).
For those not treated with statins, the hazard ratio for least fit participants ( n=1024 ) was 1.35 ( p less than 0.0001 ) and progressively decreased to 0.53 ( p less than 0.0001 ) for those in the highest fitness category ( n=1498 ).
The study has shown that statin treatment and increased fitness are independently associated with low mortality among dyslipidaemic individuals.
The combination of statin treatment and increased fitness resulted in substantially lower mortality risk than either alone, reinforcing the importance of physical activity for individuals with dyslipidaemia. ( Xagena )
Kokkinos PF et al, The Lancet 2013; 381: 394-399