Statins, ACE Inhibitors, and Physical Performance in Women
Objectives: To examine associations between angiotensin-converting enzyme (ACE) inhibitor and statin medications and baseline and mean annual change in physical performance measures and muscle strength in older women.
Design: Prospective cohort study.
Participants: Participants from the Women's Health Initiative Clinical Trials aged 65 to 79 at baseline who had physical performance measures, self-report of health insurance, and no prior history of stroke or congestive heart failure were included (N = 5,777). Women were recruited between 1993 and 1998.
Measurements: Medication use was ascertained through a baseline inventory. Physical performance measures (timed 6-m walk, repeated chair stands in 15 seconds) and grip strength were assessed at baseline and follow-up Years 1, 3, and 6. Multivariable-adjusted linear repeated-measures models were adjusted for demographic and health characteristics.
Results: ACE inhibitor use was associated with lower mean grip strength at baseline (22.40 kg, 95% confidence interval (CI) = 21.89–22.91 vs 23.18 kg, 95% CI 23.02–23.34; P = .005) and greater mean annual change in number of chair stands (−0.182, 95% CI −0.217 to −0.147 vs −0.145, 95% CI −0.156 to −0.133; P = .05) than nonuse. Statin use was not significantly associated with baseline measures or mean annual change for any outcome. A subgroup analysis suggested that statin use was associated with less mean annual change in chair stands (P = .006) in the oldest women.
Conclusion: These results do not support an association between statin or ACE inhibitor use and slower decline in physical performance or muscle strength and thus do not support the use of these medications for preserving functional status in older adults.
Maintaining adequate physical function is important for older adults to continue independent living in the community. An objective of Healthy People 2020 is to "reduce the proportion of older adults who have moderate to severe functional limitations." Performance-based measures of functional status, such as timed walk, are useful in identifying individuals at risk of disability.
Multiple factors appear to be involved in the decline in physical function and development of frailty that occurs with aging. Of special interest is that a growing body of evidence suggests a relationship between chronic inflammation and age-related muscle changes, disability, frailty, and decline in physical function. Two medication classes, angiotensin-converting enzyme (ACE) inhibitors and statins, have been identified as potential ways to reduce physical decline with aging. Although results from studies have been inconsistent, there is evidence to support a lower risk of these outcomes with ACE inhibitors and statins, particularly in select samples of individuals.
It is biologically plausible that these medications may prevent decline in physical function beyond what might be expected by reducing vascular events. ACE inhibitors may have a direct effect on muscle or may reduce inflammation, whereas statins may reduce systemic inflammation, as indicated by specific markers (e.g., C-reactive protein (CRP)). However, it is possible that the muscle-related adverse events (e.g., myalgia, muscle weakness) that have been described may counteract the benefits that statins may confer by reducing inflammation.
Because most studies have been conducted in select samples, it is important to examine this question in large representative samples. Given this background, the objective of the current study was to examine the associations between each medication class and baseline lower extremity physical performance measures and muscle strength and annual change in these measures in women aged 65 and older.
Abstract and Introduction
Abstract
Objectives: To examine associations between angiotensin-converting enzyme (ACE) inhibitor and statin medications and baseline and mean annual change in physical performance measures and muscle strength in older women.
Design: Prospective cohort study.
Participants: Participants from the Women's Health Initiative Clinical Trials aged 65 to 79 at baseline who had physical performance measures, self-report of health insurance, and no prior history of stroke or congestive heart failure were included (N = 5,777). Women were recruited between 1993 and 1998.
Measurements: Medication use was ascertained through a baseline inventory. Physical performance measures (timed 6-m walk, repeated chair stands in 15 seconds) and grip strength were assessed at baseline and follow-up Years 1, 3, and 6. Multivariable-adjusted linear repeated-measures models were adjusted for demographic and health characteristics.
Results: ACE inhibitor use was associated with lower mean grip strength at baseline (22.40 kg, 95% confidence interval (CI) = 21.89–22.91 vs 23.18 kg, 95% CI 23.02–23.34; P = .005) and greater mean annual change in number of chair stands (−0.182, 95% CI −0.217 to −0.147 vs −0.145, 95% CI −0.156 to −0.133; P = .05) than nonuse. Statin use was not significantly associated with baseline measures or mean annual change for any outcome. A subgroup analysis suggested that statin use was associated with less mean annual change in chair stands (P = .006) in the oldest women.
Conclusion: These results do not support an association between statin or ACE inhibitor use and slower decline in physical performance or muscle strength and thus do not support the use of these medications for preserving functional status in older adults.
Introduction
Maintaining adequate physical function is important for older adults to continue independent living in the community. An objective of Healthy People 2020 is to "reduce the proportion of older adults who have moderate to severe functional limitations." Performance-based measures of functional status, such as timed walk, are useful in identifying individuals at risk of disability.
Multiple factors appear to be involved in the decline in physical function and development of frailty that occurs with aging. Of special interest is that a growing body of evidence suggests a relationship between chronic inflammation and age-related muscle changes, disability, frailty, and decline in physical function. Two medication classes, angiotensin-converting enzyme (ACE) inhibitors and statins, have been identified as potential ways to reduce physical decline with aging. Although results from studies have been inconsistent, there is evidence to support a lower risk of these outcomes with ACE inhibitors and statins, particularly in select samples of individuals.
It is biologically plausible that these medications may prevent decline in physical function beyond what might be expected by reducing vascular events. ACE inhibitors may have a direct effect on muscle or may reduce inflammation, whereas statins may reduce systemic inflammation, as indicated by specific markers (e.g., C-reactive protein (CRP)). However, it is possible that the muscle-related adverse events (e.g., myalgia, muscle weakness) that have been described may counteract the benefits that statins may confer by reducing inflammation.
Because most studies have been conducted in select samples, it is important to examine this question in large representative samples. Given this background, the objective of the current study was to examine the associations between each medication class and baseline lower extremity physical performance measures and muscle strength and annual change in these measures in women aged 65 and older.
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