HealthDay News — Combining exercise with statin treatment substantially lowered mortality risk among middle-aged patients with dyslipidemia compared with either method alone, study results show.

Patients taking statins who were physically fit had as much as a 70% reduction in mortality risk during a 10-year follow-up period compared with  the least physically fit patients, Peter Kokkinos, PhD, of George Washington University in Washington, and colleagues reported in Lancet.

And exercise reduced mortality risk in patients regardless of whether they were taking statins or not, reducing the likelihood of death during follow-up by as much as 47% in patients who were not taking statins, they added.

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“Statin treatment and increased fitness are independently associated with low mortality among dyslipidemic individuals,” the researchers wrote. “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 dyslipidemia.”

To better understand the combined effects of statin therapy and exercise on mortality risk Kokkinos and colleagues conducted a prospective study involving 10,043 veterans with dyslipidemia who had undergone an exercise tolerance test between 1986 and 2011. Based on peak metabolic equivalents (MET) during the exercise test, participants were assigned to one of four fitness categories. They were then further classified into eight categories based on statin treatment and fitness status.

Patients were aged 59 years on average, had a mean BMI of about 29 kg/m2 and a peak MET of 7.4. The cohort included 5,046 statin users and 4,997 who were not taking statins.

During the 10-year follow-up period, 2,318 patients died, with an average yearly mortality rate of 22 deaths per 1,000 person-years.

Among participants taking statins, the mortality risk was significantly lower than for those not taking statins — 18.5% vs. 27.7% (P<0.0001), with mortality risk decreasing as fitness increased. 

Patients who were taking statins and were highly fit (>9 MET) had a 70% reduced risk for mortality versus the least-fit (≤5 MET) participants (P<0.0001). For participants not taking statins, those who were least fit had a 35% increase in the mortality hazard (P<0.0001), whereas the most-fit members of the group had a 47% reduction in the hazard ratio (P<0.0001).

Overall, each 1 MET increase in exercise capacity was associated with a 12% reduction in the mortality hazard (17% in the statin group, 11% in the nonstatin group), the researchers found.

In an accompanying editorial, Pedro Hallal, PhD, from the Federal University of Pelotas in Rio Grande do Sul, Brazil and I-Min Lee, MD, from Harvard Medical School in Boston, said that the study findings show that exercising is just as important as medication when it comes to managing dyslipidemia.

“The cost of becoming physically active is lower than that of buying drugs, and moderate intensity physical activity has fewer side effects” Hallal and Lee wrote. “Unlike statins, physical activity should be part of everyday life.”

Because the study involved only male veterans the findings may not be generalizable to women, the researchers acknowledged. They added that there was no data available on adverse events related to statin use that could interfere with exercise capacity.


  1. Kokkinos PF et al. Lancet. 2012; doi:10.1016/S0140-6736(12)61426-3.
  2. Hallas PC, Lee IM. Lancet. 2012; doi:10.1016/S0140-6736(12)61804-2.