Statin use may reduce lower extremity peak force via reduced engagement in muscle-strengthening activities

Stain use is often associated with an increased likelihood of musculoskeletal complications such as injuries and pain. Consequently, it is plausible to suggest that statin use may indirectly influence lower extremity muscular strength via reduced engagement in muscle-strengthening activities (MSA). However, this has yet to be examined. Therefore, the purpose of this study was to examine whether statin use was associated with muscular strength via engagement in MSA. Data from the 1999-2002 NHANES were used, with 2775 adults (50-85 years) constituting the analytic sample. Statin use was assessed from an interviewer, engagement in MSA (e.g. resistance training) was assessed via survey and lower extremity isokinetic knee extension strength (IKES) was assessed objectively using the Kin Com MP dynamometer. Weighted multivariable linear regression analysis showed no direct association between statin use and IKES (β_adjusted  = 7·0 newton ∆, P = 0·23). Statin use, however, was associated with a 35% reduced odds of engaging in MSA (OR_adjusted  = 0·65, P = 0·04), and engaging in MSA was positively associated with IKES (β_adjusted  = 19·9 newton ∆, P = 0·001). The bootstrap Barron and Kenny mediational analysis indeed demonstrated that statin use was indirectly associated with IKES via MSA (indirect effect coefficient: -0·005; 95% CI: -0·01 to -0·001; P<0·05). Statin use was not directly associated with IKES, but was indirectly associated with IKES via MSA. In conclusion, statin use may decrease muscle force by influencing engagement in MSA. We wish to suggest that a decrease in MSA may be related to an increase in muscle pain associated with statin therapy.