Are patients undergoing treatment of hyperlipidaemia with statins the best candidates for early cardiac rehabilitation? The aim of our review article is to emphasize practice and a review of the literature on this topic, that apart from the appropriate selection of drugs while obviously not negating the undeniable and doses, there should be a focus on good evidence of the beneficial effects of exercise, cooperation between the medical team and the strongly suggest that in some groups of patients patient. This cooperation would guarantee imme- special precautions should be taken, careful diate reporting of undesirable symptoms, so as to consideration made, and accuracy should be quickly withdraw the patient from the therapy and maintained in informing patients about the avoid life-threatening complications. potential side effects of combining two factors: pharmacotherapy with statins and physical exercise. Statins and exercise – good or poor The role of statins in both the prevention of CHD combination? and after acute coronary episodes has been well Cardiac rehabilitation is a good method of demonstrated in many studies [6]. One of the most treatment for patients with stable CHD, with important aims of modern medicine is to lower a history of ACS [4], percutaneous coronary cholesterol levels; some researchers call it a medical interventions (PCI) and coronary artery bypass obsession [7]. Since statin use has become grafting (CABG). A well-organized programme of common, and especially since their use has been physical training in patients with coronary introduced in recommendations for treatment of dysfunctions has many physiological, biochemical patients after an ACS, reports on substantial side and haemodynamic benefits. effects of hyperlipidaemia treatment have appeared, In Poland a three-stage model of cardiac apart from descriptions of the excellent effectiv- rehabilitation is currently used. The first stage is in- eness of these drugs. Due to the benefits of statin hospital rehabilitation. The second is early cardiac therapy proved in studies, the risk of this therapy rehabilitation practised at home, in ambulatory or tends to be underestimated. Statins belong to stationary conditions. The third stage is late a group of drugs well tolerated among patients. rehabilitation, undertaken to maintain the effects They are administered only once a day and they of previous treatments and rehabilitation, as well can be used in monotherapy or as part of as to prevent further coronary episodes. combination treatment [8]. However, they can Once the patient leaves the hospital, he is provoke various side effects, ranging from dyspeptic qualified to begin early cardiac rehabilitation. Its symptoms, through moderately intense pain foundation is rehabilitation based on exercising and ailments, to the most severe ones such as liver physical training. The essential effect of physical damage and acute cell injury in the muscular training is a decrease in the heart rate, both during system – rhabdomyolysis [9]. rest and at the time of exercise. The effect of The safety of aggressive hyperlipidaemia therapy appropriately chosen training is a reduction of the has been the subject of many analyses. The results demand of the heart for oxygen during major of the PRIMO (Prediction of Muscular Risk in exercise, which decreases the risk of acute heart Observational Conditions) study, which included ischaemia. It causes regeneration of the vascular 7924 patients with drug therapy of hyperlipidaemia endothelium and, as a result, an increase of in various doses, was published in 2005. Muscular nitrogen oxide production, which widens the symptoms were observed in 10.49% of patients. vascular bed. It enables a significant broadening of The highest risk was noted in patients taking the scope of life activities among patients. Physical simvastatin (18.2%) and the lowest (5.1%) in efficiency can increase in patients with CHD up to patients taking fluvastatin [10]. In earlier studies, 20-30% by physical rehabilitation. the average frequency of rhabdomyolysis occur- The most frequently recommended form of rence during monotherapy with atorvastatin, physical rehabilitation is interval training on pravastatin or simvastatin was 0.44, with fibrates a bicycle ergometer, because it enables precise 2.82, and with cerivastatin (1st generation statin control of load, pulse rate and blood pressure and, which was withdrawn in 2001) 5.34 cases per if needed, constant observation of heart functioning 100 000 patients per year. This frequency rose to on the monitor with a graphic record on an ECG 5.98 if atorvastatin, pravastatin or simvastatin was monitor [5]. used together with fibrates [11]. Based on studies Physicians often recommend this kind of carried out on healthy people, the frequency of treatment in support of pharmacotherapy, because moderately intense pain ailments is estimated at the results of early cardiac rehabilitation are 190, myopathy with a significant increase in promising: they improve not only the patients’ creatine kinase (CK) level at 5 and rhabdomyolysis physical efficiency but also their quality of life. at 1.6 cases per 100 000 patients per year [12]. Until now, we have only described the positive The frequency of rhabdomyolysis estimated in effects of increased physical activity in patients various studies is definitely affected by differences after ACS. However, experience from our clinical in the definition of this disease. To diagnose Arch Med Sci 5, October / 2011 757