Prescribe exercise for men with dyslipidaemiaBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8209 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8209
Statins reduce mortality in middle aged men with dyslipidaemia. Physical fitness is also associated with longer survival in this group, say researchers. We should be prescribing both⇑.
In a cohort of 10 043 adults from the US (mostly men), statins and fitness had independent effects on risk of death from all causes over 10 years. Mortality fell steadily with increasing physical fitness, in men who took statins and in those who couldn’t. The two treatments are clearly complementary, says a linked comment (doi:10.1016/S0140-6736(12)61804-2). Among men treated with statins, the most fit were 70% less likely to die than the least fit (hazard ratio 0.30, 95% CI 0.21 to 0.41). The comparable hazard ratio was 0.53 (0.44 to 0.65) in men not treated with statins.
This cohort had an average age close to 60 years when recruited. Roughly half the participants had hypertension, a fifth were smokers, and more than a third had diabetes. Cardiovascular disease was common. They had high concentrations of total cholesterol (6.1 and 6.0 mmol/L in the two statin groups) and low density lipoprotein cholesterol (4.2 and 4.0 mmol/L) at baseline. Associations were adjusted for age, sex, body mass index, other treatments for cardiovascular disease, cardiovascular history, and risk factors. The authors did further analyses to try to account for the fact that sick men don’t exercise (reverse causation).
They defined fitness using metabolic equivalents or METS, where one MET is energy expenditure at rest. Any fitness level above 5 METS was linked to lower mortality in this study, regardless of statin treatment. Men can achieve this level of fitness through moderate exercise such as light cycling, says the comment. Exercise is cheap, easy, and safe within reasonable limits. Exercise prescriptions should be the rule not the exception.
Cite this as: BMJ 2012;345:e8209