Effect of fluvastatin in combination with moderate endurance training on parameters of lipid metabolism.

OBJECTIVE: To establish whether patients receiving the cholesterol synthesis enzyme inhibitor fluvastatin 20 mg/day could obtain an additional improvement in their lipid pattern as a result of physical endurance training. DESIGN: This was an observational study using a before- and after-treatment comparison of fitness and lipid parameters in outpatients with dyslipidaemia who undertook an exercise programme with or without treatment with a lipid-lowering drug. STUDY PARTICIPANTS: Participants were 18 sedentary maximum oxygen uptake (VO2max) < 30 ml/kg bodyweight per minute] men (age range 38 to 65 years) with dyslipidaemia but without overt cardiovascular disease. INTERVENTIONS: All participants undertook a 1-hour bout of endurance training twice a week for 3 months. The training involved a circuit using various ergometers, with continuous monitoring of pulse rate, at an exercise intensity of 2 to 3 mmol/L lactate. The control group (n = 6) received no drug treatment; they completed the training programme only. The pretreatment group (n = 6) comprised participants who had already been treated with fluvastatin 20 mg/day for at least 3 months before beginning the training programme. The treatment group (n = 6) received fluvastatin 20 mg/day from the beginning of the training programme. All participants were required to comply with the exercise programme and with a standardised carbohydrate-loaded diet together with restriction of alcohol consumption to a maximum of 20 ml/day. RESULTS: In the control group, increased physical activity alone reduced serum triglyceride (TG) levels (-24.7%) and increased serum high density lipoprotein-cholesterol (HDL-C) levels (+19.3%). There was a smaller effect on serum low density lipoprotein-cholesterol (LDL-C) levels (-12.8%). Similar but smaller effects were observed in the pretreatment group (i.e. patients previously treated with fluvastatin): TG -12.88%, HDL-C +13.81%, LDL-C -8.7%. Marked changes were observed in the treatment group: TG -33.1%, HDL-C +34.7%, LDL-C -40.5%, total cholesterol -30.5%. CONCLUSIONS: A reduction of serum LDL-C level in the target range of -30 to -40% cannot be achieved by this intensity of training alone. In combination with fluvastatin 20 mg/day, however, the positive effects on lipid metabolism are potentiated. Thus, treatment with fluvastatin combined with moderate endurance training is a rational mode of therapy, particularly in patients with a highly pathological lipid profile.