Statin therapy in athletes and patients performing regular intense exercise – Position paper from the International Lipid Expert Panel (ILEP)

Katsiki, Niki; Mikhailidis, Dimitri P.; Bajraktari, Gani; Miserez, André R.; Cicero, Arrigo Francesco Giuseppe; Bruckert, Éric; Șerban, Maria-Corina; Mirrakhimov, Aibek E.; Alnouri, Fahad; Reiner, Željko; Paragh, György; Sahebkar, Amirhossein; Banach, Maciej; Amar, Fahma; Atanasov, A; Bartłomiejczyk, Marcin A.; Bjelaković, Bojko; Bielecka‐Dąbrowa, Agata; Cafferata, Alberto; Češka, Richard; Collet, Xavier; Descamps, Olivier; Nair, Devaki; Djuric, Dragan; Durst, Ronen; Ezhov, M.; Fras, Zlatko; Gaiță, Dan; Haehling, Stephan von; Hernandez, Adrián V.; Jones, Steven R.; Jóźwiak, Jacek Jerzy; Kakauridze, N.; Khera, Amit; Kostner, Karam; Kubilius, Raimondas; Latkovskis, Gustavs; Mancini, G.B. John; Ad, Marais; Martin, Seth S.; Martinez, J A; Mazidi, Mohsen; Mitchenko, O.; Moriarty, Patrick M.; Nabavi, Seyed Mohammad; Panagiotakos, Demosthenes B.; Pella, Daniel; Penson, Peter E.; Petrulionienė, Ž.; Pirro, Matteo; Postadzhiyan, Arman; Puri, Raman; Reda, Ashraf; Riadh, Jemaa; Richter, Dimitri; Rizzo, Manfredi; Ruscica, Massimiliano; Sattar, Naveed; Shehab, Abdulla; Shek, Aleksandr B.; Sirtori, Cesare R.; Stefanutti, Claudia; Tomasik, Tomasz; Tóth, Peter P.; Viigimaa, Margus; Vinereanu, Dragoş; Vohnout, Branislav; Vráblík, Michal; Wong, Nathan D.; Yeh, Hung‐I; Zhisheng, Jiang; Zirlik, Andreas

doi:10.1016/j.phrs.2020.104719

Cited by 19 publications

(18 citation statements)

References 133 publications

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“…Some studies reveal that athletes who consume high-carbohydrate or high-fat diets increase their risk of developing hypercholesterolemia. In particular, this phenomenon was observed in keto-adapted endurance athletes [22] and athletes under statin therapy [86]. Thus, further research on the effect of the LH-TL and IHT method on the lipid profile should focus on well-trained athletes whose indices of lipid profile exceed the reference ranges.…”

Section: Discussionmentioning

confidence: 98%

Exposure to Normobaric Hypoxia Combined with a Mixed Diet Contributes to Improvement in Lipid Profile in Trained Cyclists

et al. 2021

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This study aimed to analyze the effects of live high-train low method (LH-TL) and intermittent hypoxic training (IHT) with a controlled mixed diet on lipid profile in cyclists. Thirty trained male cyclists at a national level with at least six years of training experience participated in the study. The LH-TL group was exposed to hypoxia (FiO2 = 16.5%) for 11–12 h a day and trained under normoxia for 3 weeks. In the IHT group, participants followed the IHT routine three times a week under hypoxia (FiO2 = 16.5%) at lactate threshold intensity. The control group (N) lived and trained under normoxia. The results showed that the 3-week LH-TL method significantly improved all lipid profile variables. The LH-TL group showed a significant increase in HDL-C by 9.0% and a decrease in total cholesterol (TC) by 9.2%, LDL-C by 18.2%, and triglycerides (TG) by 27.6%. There were no significant changes in lipid profiles in the IHT and N groups. ∆TG and ∆TC were significantly higher in the LH-TL group compared to the N group. In conclusion, hypoxic conditions combined with a mixed diet can induce beneficial changes in lipid profile even in highly trained athletes. The effectiveness of the hypoxic stimulus is closely related to the hypoxic training method.

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Section: Discussionmentioning

confidence: 98%

Exposure to Normobaric Hypoxia Combined with a Mixed Diet Contributes to Improvement in Lipid Profile in Trained Cyclists

et al. 2021

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“…Before implementation of regular exercise to a patient's daily routine, cardiovascular function should be assessed, especially for adult patients with FH [13,20]. Moreover, all patients should be warned about potential muscle aches and pains to avoid minor skeletal injuries resulting from exercise being misattributed to statin therapy [21].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Familial Hypercholesterolemia in Children and Adults in EAS-FHSC Regional Center for Rare Diseases in Poland

Lewek

Konopka

Starostecka

et al. 2021

JCM

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Background: Familial hypercholesterolemia (FH) is a genetic autosomal co-dominant metabolic disorder leading to elevated circulating concentrations of low-density lipoprotein cholesterol (LDL-C). Early development of atherosclerotic cardiovascular disease (ASCVD) is common in affected patients. We aimed to evaluate the characteristics and differences in the diagnosis and therapy of FH children and adults. Methods: All consecutive patients who were diagnosed with FH, both phenotypically and with genetic tests, were included in this analysis. All patients are a part of the European Atherosclerosis Society FH-Study Collaboration (FHSC) regional center for rare diseases at the Polish Mother’s Memorial Hospital Research Institute (PMMHRI) in Lodz, Poland. Results: Of 103 patients with FH, there were 16 children (15.5%) at mean age of 9 ± 3 years and 87 adults aged 41 ± 16; 59% were female. Children presented higher mean levels of total cholesterol, LDL-C, and high-density lipoprotein cholesterol (HDL-C) measured at the baseline visit (TC 313 vs. 259 mg/dL (8.0 vs. 6.6 mmol/L), p = 0.04; LDL 247 vs. 192 mg/dL (6.3 vs. 4.9 mmol/L), p = 0.02, HDL 53 vs. 48 mg/dL (1.3 vs. 1.2 mmol/L), p = 0.009). Overall, 70% of adult patients and 56% of children were prescribed statins (rosuvastatin or atorvastatin) on admission. Combination therapy (dual or triple) was administered for 24% of adult patients. Furthermore, 13.6% of adult patients and 19% of children reported side effects of statin therapy; most of them complained of muscle pain. Only 50% of adult patients on combination therapy achieved their treatment goals. None of children achieved the treatment goal. Conclusions: Despite a younger age of FH diagnosis, children presented with higher mean levels of LDL-C than adults. There are still urgent unmet needs concerning effective lipid-lowering therapy in FH patients, especially the need for greater use of combination therapy, which may allow LDL-C targets to be met in most of the patients.

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“…The development of statin-related myopathy may be enhanced by acute and chronic physical exercises. According to the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS), individuals affected by dyslipidemias should be encouraged to practice regular (30 min/day) moderate physical activity, but they have to must to pay attention to myopathy and creatine kinase (CK) elevation related to statin treatment [39]. It has been suggested that obsessive features of sport activities (guilt over skipping training, counting calories during training) play an important role in ON [40].…”

Section: Discussionmentioning

confidence: 99%

Dietary Habits and Musculoskeletal Pain in Statin and Red Yeast Rice Users: A Pilot Study

Raguzzini¹,

Toti²,

Palmery

et al. 2021

EJIHPE

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(1) Background: Diet and statins are commonly used to treat high cholesterol (CHOL) levels. (2) Aim: To compare adherence to Mediterranean diet (Med-D), orthorexia nervosa (ON), and musculoskeletal pain in individuals in treatment with statins metabolized by CYP3A4, not metabolized by CYP3A4 or red yeast rice (RYR, containing monacolin K: MON-K). (3) Methods: starting from 80 individuals, after the exclusion of those with other causes of possible pain, 56 individuals were selected and divided into three groups according to the type of statin (CYP3A4, NO-CYP3A4 and MON-K). Adherence to the Med-D was evaluated with the MEDScore and a sub-score was calculated for fruit and vegetables consumption (MEDScore-FV). ON and musculoskeletal pain were assessed with the ORTO-15 and with the Nordic Musculoskeletal questionnaires, respectively. A retrospective analysis of CHOL decrease after treatment was conducted. (4) Results: CHOL levels were lower in CYP3A4 and NO-CYP3A4 after treatment (182.4 ± 6.3 and 177.0 ± 7.8 mg/dL, respectively), compared with MON-K (204.2 ± 7.1 mg/dL, p < 0.05). MON-K and CYP3A4 groups had a high prevalence of reported knee pain (33.3% and 18.8%, respectively) than NO-CYP3A4 group (0%, p < 0.05). A high percentage of individuals in MON-K take supplements and nutraceuticals (87.5%), whereas MEDScore-FV was higher in CYP3A4 (9.4 ± 0.2) compared to NO-CYP3A4 (7.6 ± 0.5, p < 0.05). (5) Conclusions: This study suggests that individuals receiving treatment with statins and RYR should be monitored from the perspective of plant foods’ consumption and nutraceutical use, to prevent musculoskeletal pain.

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Statin therapy in athletes and patients performing regular intense exercise – Position paper from the International Lipid Expert Panel (ILEP)

Cited by 19 publications

References 133 publications

Exposure to Normobaric Hypoxia Combined with a Mixed Diet Contributes to Improvement in Lipid Profile in Trained Cyclists

Exposure to Normobaric Hypoxia Combined with a Mixed Diet Contributes to Improvement in Lipid Profile in Trained Cyclists

Clinical Features of Familial Hypercholesterolemia in Children and Adults in EAS-FHSC Regional Center for Rare Diseases in Poland

Dietary Habits and Musculoskeletal Pain in Statin and Red Yeast Rice Users: A Pilot Study

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