{"product_id":"paul-d-thompson-statins-exercise-creatine-kinase-15","title":"Statins \u0026 exercise. High creatine kinase 15","description":"\u003ch1\u003eCreatine Kinase on a Statin: Exercise, Muscle Injury and When to Stop\u003c\/h1\u003e\n\u003ch3\u003eJump To Section\u003c\/h3\u003e\n\u003cul\u003e\n  \u003cli\u003e\u003ca href=\"#ck-marker\"\u003eA marker of muscle injury\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#downhill-exercise\"\u003eDownhill exercise and muscle injury\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#statin-studies\"\u003eWhat his statin studies showed\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#when-to-stop\"\u003eWhen the statin is stopped\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#weighing-risks\"\u003eWeighing muscle injury against heart attack and stroke\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#full-transcript\"\u003eFull Transcript\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2 id=\"ck-marker\"\u003eA marker of muscle injury\u003c\/h2\u003e\n\u003cp\u003eCreatine kinase (CK) is a blood marker of muscle injury. Dr. Anton Titov, MD, asks cardiologist Dr. Paul D. Thompson, MD, what such a level means and when it needs urgent care. Dr. Thompson calls it a bit of a tough question.\u003c\/p\u003e\n\u003ch2 id=\"downhill-exercise\"\u003eDownhill exercise and muscle injury\u003c\/h2\u003e\n\u003cp\u003eDownhill running and walking can injure skeletal muscle. His group has often measured CK in Boston Marathon runners, a race he calls downhill: it loses 440 feet over 26 miles, going down, up the Newton Hills, and down again.\u003c\/p\u003e\n\u003cp\u003eMountain hikers know the effect, he says: they hurt more the day after walking out than the day climbing up, because a muscle that contracts while it is stretched can be injured.\u003c\/p\u003e\n\u003ch2 id=\"statin-studies\"\u003eWhat his statin studies showed\u003c\/h2\u003e\n\u003cp\u003eStatins alone raise creatine kinase a little. In a large study by his group, 420 people were randomized to atorvastatin 80 milligrams or to placebo, and average CK rose 21 points more, about 10% more, with the statin.\u003c\/p\u003e\n\u003cp\u003eWalking downhill for 45 minutes on a statin produced about a doubling in the evidence of muscle injury compared with placebo. He sees this as support for his proposal that statins do have an effect on skeletal muscle. In most people the effect is not severe, is easily tolerated and does not seem to interfere with muscle function, but the CK elevation can be an issue.\u003c\/p\u003e\n\u003ch2 id=\"when-to-stop\"\u003eWhen the statin is stopped\u003c\/h2\u003e\n\u003cp\u003eThe decision to stop the statin depends on symptoms and the CK level. Dr. Thompson's team does not stop it if the person has no symptoms, and does not stop it until CK reaches 10 times the upper limits of normal. If the person exercised the day before, they may let it go even higher.\u003c\/p\u003e\n\u003ch2 id=\"weighing-risks\"\u003eWeighing muscle injury against heart attack and stroke\u003c\/h2\u003e\n\u003cp\u003eHe still regards a raised CK on a statin as a sign of some muscle injury. His reasoning comes back to what is going to kill you: a mild muscle injury will not, while a heart attack or a stroke, as he puts it, can ruin your whole day.\u003c\/p\u003e\n\u003ch2 id=\"full-transcript\"\u003eFull Transcript\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Anton Titov, MD:\u003c\/strong\u003e Creatine kinase on a statin, a blood marker of muscle injury with statins and exercise. You were first author of a randomized clinical trial of a statin and downhill treadmill walking. The muscle injury marker rose more with the statin than with placebo. On your blog you wrote that hard exercise alone also raises creatine kinase. Professor Thompson, what does a high creatine kinase level mean for a patient on a statin? When does a high creatine kinase level need urgent care?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e That is a bit of a tough question, because creatine kinase is a marker of muscle injury. For example, we have measured it a lot of times on people running the Boston Marathon, and the Boston Marathon is actually a downhill race. It starts in Hopkinton, Mass.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e You go downhill right away. You run along, and then you go up the Newton Hills, and then you go down again. So the Boston Marathon actually loses 440 feet over those 26 miles, and it does it two times, because you go low, you go high, you go low again.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e So downhill running, downhill walking can injure skeletal muscle. And those of you who are mountain hikers know that. You hurt more the day after walking out than the day climbing up, because when the muscle has to contract and it is stretched at the same time, that can injure skeletal muscle.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e A rise in the creatine kinase is a marker of muscle injury. It goes up a little bit with statins alone. In the big study we did, 420 people randomized to a high dose of atorvastatin, 80 milligrams, or randomized to placebo, the average CK went up 21 points more, about 10% more, in the statin group than in the placebo group.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Now, if you exercise on a statin, we showed, as Anton pointed out, that if you downhill walk for 45 minutes on a statin versus on a placebo, you get about a doubling in the evidence of muscle injury. This just goes along with my proposal that statins do have an effect on skeletal muscle. It is not severe in most people, easily tolerated in most people, and does not seem to interfere with muscle function, but the elevation of creatine kinase can be an issue.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e When do you stop the statin? We do not stop it if the person does not have any symptoms. We do not stop the statin until the CK is 10 times the upper limits of normal.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e That is the usual, and if they have exercised the day before or something, we will even let it go higher. But we do think that the elevation of creatine kinase is a marker that the muscle has some injury on statins. It goes back to the thing: what is going to kill you?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e A mild muscle injury is not going to kill you. A heart attack or a stroke can ruin your whole day if it is your heart attack or if it is your stroke.\u003c\/p\u003e\n","brand":"Diagnostic Detectives Network","offers":[{"title":"Default Title","offer_id":48388642111644,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/2225155328-174af49806aa526ac0d84a5bfc465109652f7e0d150fd1bd3ea122b7a3f86aa2-d_1920x1080_33ca62fd-17dd-49c2-a8c6-ee0cf4a6602f.jpg?v=1794435416","url":"https:\/\/diagnosticdetectives.com\/da\/products\/paul-d-thompson-statins-exercise-creatine-kinase-15","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}