The creatine kinase response to eccentric exercise with atorvastatin 10 mg or 80 mg.
BACKGROUND
Hydroxy-methyl-glutaryl co-enzyme A (HMG-CoA) reductase inhibitors or statins are well tolerated by most patients, but can produce a variety of skeletal muscle problems including myalgia, creatine kinase (CK) elevations and clinically important rhabdomyolysis. We have previously demonstrated that the CK response to downhill walking is greater in statin compared to placebo treated subjects. This study examined the CK response to downhill walking in subjects treated with low and high dose of atorvastatin.


METHODS
79 subjects with LDL cholesterol>100mg/dL were randomly assigned to atorvastatin 10mg (N=42) or 80 mg (N=37) for 5 weeks. Subjects performed a downhill walking exercise during the fifth week of treatment. Leg muscle soreness, plasma CK and CK-MB levels were measured daily for 4 days following the exercise.


RESULTS
CK, CK-MB and muscle soreness increased above pre-exercise levels in all subjects after the exercise. There were no differences in the CK, CK-MB or soreness response between the high and low dose treatment groups at any time point.


CONCLUSIONS
The downhill walking model of muscle injury does not distinguish between high and low dose atorvastatin therapy either because this test is insensitive to differences among statin doses or because there is no difference in muscle injury between these two drug doses with this statin. Clinicians should be aware, however, that exercise can increase CK levels with even low dose statin therapy.
Kearns
Amy K
AK
Division of Cardiology, Henry Low Heart Center, Hartford Hospital, 87 Seymour Street, Hartford, CT 06102, USA.
Bilbie
Cherie L
CL
Clarkson
Priscilla M
PM
White
C Michael
CM
Sewright
Kim A
KA
O'Fallon
Kevin S
KS
Gadarla
Mamatha
M
Thompson
Paul D
PD
D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000069059:Atorvastatin; D003402:Creatine Kinase / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects* / Q000201:enzymology*; D010146:Pain / Q000209:etiology; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects*
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D003402:Creatine Kinase