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Study of 10,000 Veterans with lipid problems confirms benefits of fitness, statins

Dr. Peter Kokkinos, of the Washington, DC, VA Medical Center, has led numerous studies exploring the impact of physical fitness on longevity. His latest study looked at the combination of fitness and statin drugs.
Fitness findings—Dr. Peter Kokkinos, of the Washington, DC, VA Medical Center, has led numerous studies exploring the impact of physical fitness on longevity. His latest study looked at the combination of fitness and statin drugs. (Photo by Robert Turtil)

In the first study of the combined effects of increased fitness and statin drugs, VA researchers found that the one-two punch is highly effective for those with abnormal cholesterol and triglycerides. The findings, based on the outcomes of more than 10,000 VA patients, went online Nov. 28 in the British journal The Lancet.

Many studies have established the life-extending benefits of physical activity and fitness, and other studies have shown that statins boost survival for heart patients. The new study is the first to look at both factors together in the same study population.

The findings are based on a study of more than 10,000 Veterans at the Washington, DC, VA Medical Center and the VA Palo Alto Healthcare System. Most of the Veterans were in their 50s or 60s, and most were male. All had abnormal lipids. Commonly, this means high total cholesterol, high LDL ("bad") cholesterol, low HDL ("good") cholesterol, or high triglycerides. About half the participants were taking statin drugs for three months or longer; the others were not on statins at all. The Veterans all took a treadmill test to determine their level of fitness.

Exercise reduces risk by at least half

The researchers tracked the survival of all the participants throughout the duration of the study, from 1986 through 2011.

The data showed that statins alone increased survival, as did fitness. The best-case scenario—the lowest mortality—was when both were combined. Among the specific findings:

  • The overall risk of death during the study period was around 19 percent for those taking statins and 28 percent for those not on the drugs.
  • The fittest participants, whether they were taking statins or not, had a 60 to 70 percent lower risk of death, compared to the least fit Veterans in the study.
  • When moderate and high-fit participants not taking statins were compared against low-fit participants taking the drugs, the fitter Veterans had up to a 50 percent lower risk of death.

"The take-home message is that the combination of statins and increased fitness is the most effective way to lower mortality for those with lipid abnormalities," said study leader Peter Kokkinos, PhD. "If statin therapy is not an option, then increasing fitness is essential. It's an effective, inexpensive approach to defend against premature death."

Among the most striking findings, says Kokkinos, is that regardless of statin use, "If you exercise, you're going to reduce your risk by at least half."

Based on the study results, he says people with abnormal lipids can benefit significantly by raising their fitness to at least a moderate level. While acknowledging the benefits of statins, he points out that "better fitness improves survival significantly and is a valuable additional treatment or an alternative when statins cannot be taken." He notes that muscle aches occur as a side effect of statins among about a quarter of users, and there are also other possible side effects to the cholesterol-lowering drugs.

Kokkinos conducts research and runs fitness programs at the Washington, DC, VA Medical Center. He says even everyday activities such as walking and gardening—and certainly gym classes—can help most people achieve a level of fitness that protects against early death.

"Inactivity kills," said Kokkinos, also a professor of medicine at Georgetown and George Washington universities. "This comes through over and over again in the studies, no matter what type of population we're assessing."

Kokinnos' coauthors were Charles Faselis, VA and George Washington University; Jonathan Myers, VA and Stanford University; and Demosthenes Panagiotakos and Michael Doumas, both with VA.

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