Effects of statin therapy and exercise on postprandial triglycerides in overweight individuals with hypercholesterolaemia

Abstract

Aims: To determine the effects of statins on postprandial lipaemia (PPL) and to study if exercise could enhance statin actions.

Methods: Ten hypercholesteraemic (blood cholesterol 204 ± 36 mg dL-1 ; low-density lipoprotein-cholesterol 129 ± 32 36 mg dL-1 ) overweight (body mass index 30 ± 4 kg m-2 ), metabolic syndrome individuals chronically medicated with statins (>6 months) underwent 5-hour PPL tests in 4 occasions in a randomized order: (i) substituting their habitual statin medication by placebo for 96 hours (PLAC trial); (ii) taking their habitual statin medicine (STA trial); (iii) placebo combined with a bout of intense aerobic exercise (EXER+PLAC trial); and (iv) combining exercise and statin medicine (EXER+STA trial).

Results: Before the fat meal, statin withdrawal (i.e. PLAC and EXER+PLAC) increased blood triglycerides (TG; 24%), low-density lipoprotein-cholesterol (31%) and total cholesterol (19%; all P < .05) evidencing treatment compliance. After the meal, statin withdrawal increased 5-hour postprandial TG (PPTG) compared to its matched trials (94% higher PLAC vs STA and 45% higher EXER+PLAC vs EXER+STA; P < .05). EXER+PLAC trial did not lower PPTG below PLAC (i.e. incremental AUC of 609 ± 152 vs 826 ± 190 mg dL-1 5 h; P = .09). Adding exercise to statin did not result in larger reductions in PPTG (i.e. EXER+STA vs STA incremental area under the curve of 421 ± 87 vs 421 ± 84 mg dL-1 5 h; P = .99).

Conclusion: In hypercholesteraemic metabolic syndrome individuals, chronic statin therapy blunts the elevations in TG after a fat meal (i.e. incremental area under the curve of PPTG) reducing the cardiovascular risk associated to their atherogenic dyslipidaemia. However, a single bout of intense aerobic exercise before the high fat meal, does not reduce PPTG but also does not interfere with the effects of statin treatment.

Keywords: aerobic exercise; hydroxymethylglutaryl-CoA reductase inhibitor; hypercholesterolaemia; metabolic syndrome X; postprandial lipaemia.

Conflict of interest statement

The authors report no potential conflicts of interest. The team physician had direct clinical responsibility for patients.

© 2020 The British Pharmacological Society.

Figures

Figure 1

Postprandial blood triglyceride response to a high fat meal: (A) hourly concentrations and (B) incremental area under the curve (iAUC) for the 4 experimental trials (i.e. with and without exercise and statin). Data are presented as mean ± standard error of the mean for 10 hypercholesteraemic metabolic syndrome individuals. * significantly higher when statin medicine was withdrawn compared to its matched trial with statins (i.e. PLAC vs EXER+PLAC and STA vs EXER+STA; P < .05)

Figure 2

Blood serum concentration of (A) total cholesterol and (B) low‐density lipoprotein–cholesterol (LDL‐c) response to the 4 experimental trials (i.e. with and without exercise and statin). Data are presented as mean ± standard error of the mean for 10 hypercholesteraemic metabolic syndrome individuals. * significantly higher when statin medicine was withdrawn compared to its matched trial with statins (i.e. PLAC vs EXER+PLAC and STA vs EXER+STA; P < .05)

Figure 3

(A) Resting energy expenditure and (B) fat oxidation prior to and 1, 3 and 5 hours after treatments for the 4 experimental trials. Data are presented as mean ± standard error of the mean for 10 hypercholesteraemic metabolic syndrome individuals. * Area under the curve values were significantly higher when statin was withdrawn in comparison to its matched trial with statins (P < .05). † Area under the curve values were significantly higher in the trial with exercise in comparison to its matched trial without exercise (P < .05)