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Original Investigation |

Statins and Physical Activity in Older Men: The Osteoporotic Fractures in Men Study

David S. H. Lee, PharmD, PhD1; Sheila Markwardt, BS1; Leah Goeres, PharmD1; Christine G. Lee, MD2,3; Elizabeth Eckstrom, MD, MPH4; Craig Williams, PharmD1; Rongwei Fu, PhD5; Eric Orwoll, MD3; Peggy M. Cawthon, PhD6; Marcia L. Stefanick, PhD7; Dawn Mackey, PhD6; Douglas C. Bauer, MD8; Carrie M. Nielson, PhD5
[+] Author Affiliations
1Department of Pharmacy Practice, Oregon State University/Oregon Health and Science University College of Pharmacy, Portland
2Research Service, Department of Veterans Affairs Medical Center, Portland, Oregon
3Division of Endocrinology, Department of Medicine, Diabetes and Clinical Nutrition, Oregon Health and Science University School of Medicine, Portland
4Division of General Medicine and Geriatrics, Oregon Health and Science University School of Medicine, Portland
5Department of Public Health and Preventive Medicine, Oregon Health and Science University School of Medicine, Portland
6California Pacific Medical Center Research Institute, San Francisco
7Prevention Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
8Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2014;174(8):1263-1270. doi:10.1001/jamainternmed.2014.2266.
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Importance  Muscle pain, fatigue, and weakness are common adverse effects of statin medications and may decrease physical activity in older men.

Objective  To determine whether statin use is associated with physical activity, longitudinally and cross-sectionally.

Design, Setting, and Participants  Men participating in the Osteoporotic Fractures in Men Study (N = 5994), a multicenter prospective cohort study of community-living men 65 years and older, enrolled between March 2000 and April 2002. Follow-up was conducted through 2009.

Exposures  Statin use as determined by an inventory of medications (taken within the last 30 days). In cross-sectional analyses (n = 4137), statin use categories were users and nonusers. In longitudinal analyses (n = 3039), categories were prevalent users (baseline use and throughout the study), new users (initiated use during the study), and nonusers (never used).

Main Outcomes and Measures  Self-reported physical activity at baseline and 2 follow-up visits using the Physical Activity Scale for the Elderly (PASE). At the third visit, an accelerometer measured metabolic equivalents (METs [kilocalories per kilogram per hour]) and minutes of moderate activity (METs ≥3.0), vigorous activity (METs ≥6.0), and sedentary behavior (METs ≤1.5).

Results  At baseline, 989 men (24%) were users and 3148 (76%) were nonusers. The adjusted difference in baseline PASE between users and nonusers was −5.8 points (95% CI, −10.9 to −0.7 points). A total of 3039 men met the inclusion criteria for longitudinal analysis: 727 (24%) prevalent users, 845 (28%) new users, and 1467 (48%) nonusers. PASE score declined by a mean (95% CI) of 2.5 (2.0 to 3.0) points per year for nonusers and 2.8 (2.1 to 3.5) points per year for prevalent users, a nonstatistical difference (0.3 [−0.5 to 1.0] points). For new users, annual PASE score declined at a faster rate than nonusers (difference of 0.9 [95% CI, 0.1 to 1.7] points). A total of 3071 men had adequate accelerometry data, 1542 (50%) were statin users. Statin users expended less METs (0.03 [95% CI, 0.02-0.04] METs less) and engaged in less moderate physical activity (5.4 [95% CI, 1.9-8.8] fewer minutes per day), less vigorous activity (0.6 [95% CI, 0.1-1.1] fewer minutes per day), and more sedentary behavior (7.6 [95% CI, 2.6-12.4] greater minutes per day).

Conclusions and Relevance  Statin use was associated with modestly lower physical activity among community-living men, even after accounting for medical history and other potentially confounding factors. The clinical significance of these findings deserves further investigation.

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Mean Physical Activity Scale in the Elderly (PASE) Scores According to Statin User Groups

PASE scores were estimated by mixed-effects linear regression adjusted for age, site, and baseline total cholesterol (fixed-in-time), myocardial infarction, stroke, hypertension, diabetes, perceived health and body mass index (time-varying). The error bars represent 95% confidence intervals for the estimated mean PASE at each visit (n = 3039).

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