statin and fitness provide additive mortality benefit

No big shocker.  Turns out the statins and increased exercise fitness are synergistic in mortality benefit in study of veterans (see cad statin and fitness additive lancet 2013 in dropbox).  In brief:
 
--10K people, median age 59, who had ETT between 1986-2011 (these results were used to determine their fitness, based on peak MET achieved) and reviewed for use of statins, followed ave of 10 years. This was just number-crunching analysis (people may have gotten their lipids checked routinely or to assess ischemia sx and happened to have an exercise test for whatever reason)
 
--primary outcome all-cause mortality
--ave chol pretreatment was the same (232) as well as HDL (46) and LDL (154), though chol decreased in those on statins (170 vs 197) and LDL (100 vs 139) without change in HDL
--mortality rate was 18.5% in those on statins vs 27.7% on those not.
--in those on statins: those most fit had 70% lower mortality than those least fit.
--in those not on statins: those most fit (as compared to those least fit on statins as the reference) there was a 47% decreased mortality and in those most fit a 35% increased mortality
--both fitness and statins clearly affected mortality highly significantly, with clear benefit of statins in each fitness category; however, the most fit group (>9.0 METs) not on statins had about the same mortality as the moderate to fit range (5.1-9 METs) on statins (lots of numbers in the article, but for your reference, mortality % for least fit/no statin=52% dec to 37% with statin; moderately fit with not statin 34% vs 21% with statin; fit with no statins 20% vs 10% with statin, highly fit with no statin 13% vs 6% with statin.
 
 
Note that this is an observational study (ie not an intervention study where statin +/- exercise given and check on outcome).  Since a reasonable percentage of fitness is genetic and not related to actually working out in the gym, hard to make firm conclusions.  But, it does reinforce that we should (probably) be discussing lifestyle issues pretty aggressively even in those on statins (ie, not just perscribe statin for cardioprotection/mortality benefit and leave it at that).

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