Statins, angiotensin-converting enzyme inhibitors, and physical performance in older women

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.

Figure 1

Multivariable-Adjusted Linear Repeated Measures Analyses of Physical Performance Measures and Grip Strength by Baseline Statin Use Linear estimate and 95%CI (solid and dashed lines) from a multivariable adjusted linear repeated measures model. Models were adjusted for age, ethnicity, education, BMI, alcohol consumption, systolic blood pressure, diastolic blood pressure, self-reported health, number of antihypertensive medications, diabetes, depressive symptoms, history of CHD, hormone trial randomization, and ACE use. The minimum sample size (baseline, year 1, year 3, year 6) for three outcome measures was n= (496, 436, 419,377) for statin users and n= (4852, 4243, 4189, 3768) for non-users.

Figure 2

Multivariable-Adjusted Linear Repeated Measures Analyses of Physical Performance Measures and Grip Strength by Baseline Angiotensin-Converting Enzyme (ACE) Inhibitor Use Linear estimate and 95%CI (solid and dashed lines) from a multivariable adjusted linear repeated measures model. Models were adjusted for age, ethnicity, education, BMI, alcohol consumption, systolic blood pressure, diastolic blood pressure, self-reported health, number of antihypertensive medications, diabetes, depressive symptoms, history of CHD, hormone trial randomization, and statin use. The minimum sample size (baseline, year 1, year 3, year 6) for the three outcome measures was n= (551, 477, 460, 410) for ACE users and n= (4797, 4201, 4148, 3734) for non-users.