Michael Carter, August 28, 2019
Statin therapy and physical exercise, including resistance training and cardiovascular workouts, offer several benefits for HIV-positive individuals with high blood lipids, according to Brazilian research published in Medicine & Science in Sports & Exercise. Statins and exercise were beneficial individually, but the best results were observed in individuals who combined the two. Lipid levels decreased, as did markers of inflammation associated with an increased risk of cardiovascular disease, while body composition, cardiovascular fitness, and muscle strength also improved.
"This is the first study to evaluate the combination of statins and physical training in people living with HIV who have dyslipidemia," the authors write. "Although the results suggest that either statins or physical training alone showed positive results, the combination of both was more effective."
Cardiovascular disease is a major cause of serious illness and death among people living with HIV. Reasons for this include the aging of the HIV-positive population, the inflammatory effects of untreated HIV infection, lifestyle factors such as smoking, and the side effects of some antiretroviral medications.
Statin therapy can lead to improvements in lipids and also reduces systemic inflammation, both of which are implicated in the risk of cardiovascular disease. Statins have been shown to be safe and effective in people living with HIV. Previous research has also demonstrated the benefits of physical exercise for people with HIV. These include reductions in lipids, improvements in inflammatory markers, and also increases in lean body mass, muscle strength, and cardiovascular fitness.
Studies with HIV-negative individuals have shown that combining statin therapy with an exercise regimen improves lipid and inflammatory profiles, while also improving physical fitness.
Researchers led by Dr. Hugo Ribeiro Zanetti wanted to see if combining statins with physical exercise had similar benefits for HIV-positive adults with high blood lipid levels. Therefore, they designed a double-blind, placebo-controlled study involving 83 adults receiving care at the infectious diseases clinic of the Federal University of Triânglo Mineiro in Uberaba, Brazil.
All participants had been taking antiretroviral therapy for at least one year and had an undetectable viral load. They also had confirmed dyslipidemia (triglycerides of at least 150 mg/dL; total cholesterol of at least 190 mg/dL; LDL cholesterol of at least 130 mg/dL; and HDL cholesterol below 40 mg/dL).
Participants were randomly assigned to one of four groups: placebo; statins exercise plus placebo; exercise plus statins.
Statin therapy consisted of a single daily pill containing 10 mg of rosuvastatin. Exercise regimens included a combination of resistance training and treadmill sessions three times per week. Exercise intensity was gradually increased over the 12 weeks of the study.
At the beginning and end of the study, participants underwent a series of tests. These included assessments of body composition, blood lipids, cardiovascular and inflammatory markers, carotid artery ultrasound, muscle strength, and cardiorespiratory fitness.
The average age of the participants was 42 years. The majority (51%) were male and white (72%). Hypertension was present in 22%, a quarter were diabetic, and 31% were smokers. The mean BMI was 24 kg/m², firmly in the overweight category.
There were no significant initial differences between the four study groups.
Eleven participants (13%) withdrew during follow-up.
BMI remained comparable among the four groups at the end of the study. However, improvements in lean body mass and body fat percentage were observed in the groups randomly assigned to exercise. Similar improvements were not observed in the placebo and statin-only groups. (These improvements, and all those reported below, were statistically significant.)
Improvements were observed in all lipid parameters in the statin, exercise/placebo, and exercise/statin arms. Furthermore, improvements in total cholesterol and triglycerides in the exercise/statin group exceeded those observed in the statin and exercise/placebo study arms.
Compared to the placebo group, significant reductions in inflammatory markers were observed in the statin, exercise/placebo, and exercise/statin groups. The exercise/statin group showed reductions relative to both the exercise/placebo and statin arms.
There were reductions in cardiovascular risk markers in the statin, exercise/placebo, and exercise/statin groups compared to the placebo group.
“This study… confirms that an intervention with statins, physical training, and the combination of both have a positive effect on confirmed lipid levels compared to the placebo group,” the authors comment. “The current results also demonstrate that physical training is an effective non-pharmacological intervention for improving the lipid profile of people living with HIV, independent of statin use; the mechanisms responsible for this improvement are related to enhanced lipid metabolism.”
The carotid artery ultrasound examination findings also favored the statin, exercise/placebo, and exercise/statin groups compared to the placebo group, with the exercise/placebo and exercise/statin groups having advantages over the placebo and statin arms.
Strength in all major muscle groups improved among participants in both the exercise/placebo and exercise/statin arms. Similarly, individuals in the exercise groups experienced improvements in their cardiorespiratory fitness.
The study only lasted three months. Therefore, more research is needed to see if the benefits observed by the researchers are maintained in the long term.
"Current findings show that the combination of exercise and statins is useful for controlling lipid and inflammatory profiles, reducing cardiovascular disease markers, and improving ultrasound findings, muscle strength, and cardiorespiratory fitness in people living with HIV with dyslipidemia," the authors conclude.
References
Zanetti HR et al. Effects of physical training and statin use in people living with HIV with dyslipidemia. Medicine & Science in Sports and Exercise, online edition, doi: 10.1249/MSS.0000000000002120, 2019.
From: http://www.aidsmap.com/news/aug-2019/combining-statins-and-physical-exercise-has-big-benefits-people-hiv-and-high-lipids