Question for the podcast - statins and performance

I starting having PVCs [Premature Ventricular Contractions] a few years ago. They seem to last a few weeks to a month and I have had 4 or 5 episodes over 3 years. I saw a cardiologist about this and ended up getting an Angiogram. This discovered that I had restricted blood flow in an artery (LAD) and a stent was put in. I was put on baby aspirin and a statin.

Up until that point I had been cycling a lot and doing interval/hill training with a group once a week. I also cycled across Canada the previous year. I had a bunch of tests (ECG, ultra sound, stress tests) after I had recovered from the angiogram and was told my heart was very healthy. The ultrasound practitioner said I had the heart of a 40 year old (I am 60).

After not cycling for about 4 months I started easy cycling again slowly building up to hill climbs and sweet spot intervals. I found it hard to get back to my old fitness level. I felt that my muscles didn’t want to perform the harder intervals and would be more painful than before. I talked to my cardiologist and we tried a different statin. For a few months this seemed better and my FTP began to climb. But now I am beginning to get the leg pain again and struggle with hard intervals over a minute. I am talking to my cardiologist in about a week and want to be better prepared to talk to him about this issue.

I searched the forum and read some conversations about statins and see that they can cause muscle issues. I am taking CoQ10 supplement which has been suggested. I eat healthily and sleep well but I miss the fitness I had before the stent. I read in the forums that Chad had talked about statins but could not find a podcast than mentioned statins in the description. I would love to hear what you have to say on the subject.

John [Vancouver BC]

At our age (>60) consider supplementing with ubiquinol, the active form of CoQ-10. Conversion of CoQ-10 to ubiquinol declines with age.

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Tell me more about your PVCs. I started having what my physician believes are PVCs about a month ago. Initial EKG was clean and I have a follow up this week, likely for a holter monitor and/or cardiologist referral. As of the last few days they seem like they’re going away, which would be right in line with your 3 week to month-long episodes. Anecdotally these seem to be extremely common among cyclists, but are rarely discussed.

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I first noticed them trying to measure my HRV with the HRV4 Training app which measures your heart rate and displays it like an oscilloscope would. It was quite obvious that some of the gaps between heartbeats where much longer. I talked to my doctor about this and he could hear it with a stethoscope. I too did an EKG and had a holter monitor for 24 hours (not fun to sleep in). In the end they went away. The cardiologist seemed more interested in my general heart health (heart disease, etc) so we did an angiogram where they found a constriction and hence the stent. The PVCs had stopped before that. He said that PVCs can go away, stay the same or get worse and that they can be caused by a few different things. At this point I don’t know what causes mine. I think the cardiologist is not interested in them. He seems super busy and our meetings are at breakneck pace and short. Let me know how you get on or if you have any more questions. How did you discover you might have PVCs?

Hi, I am sorry to hear about your stent. I had an MI that was silent and was started on statins. I don’t know when it happened and it was minor. I slowed up for a time but am now getting my fitness back. This happened about 2 years ago. The statins have not caused any muscle pains but I am on a low dose. I do not take CoQ 10. There is not solid evidence that it is beneficial. I did eat a vegan diet and lost about 6.8 kilos (15 lbs). My total cholesterol is now 125 with an LDL of 55 and an HDL of 60. I also passed out after this MI and had a very low blood pressure. So’ I have an embedded heart monitor that sends signal over cell phone lines and records any arrhythmias. I hope you start feeling better and get back to normal.

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Mine manifest as the feeling of a random, single heavy heartbeat. It feels like it takes my breath away, but I can have it in the middle of a conversation and it doesn’t have any actual effect, aside from a very disturbing momentary sensation. I’ve been familiar with the feeling my whole life, but about a month ago I started noticing them more frequently one night laying in bed- I woke up in the middle of the night and for no reason they were happening every few minutes, and were frightening enough to keep me up the rest of the night. They’ve waxed and waned over the last few weeks since, scaring me about training (but rarely noticeable when actually riding) to the point where I skipped a ramp test and have tried to keep things at sweet spot and below until I get a definitive all-clear. Caffeine and alcohol are known to worsen PVCs but reducing and eliminating both have had no noticeable effect. Hydration does seem to play a part for me. From their worst last weekend, where I was probably consistently noticing them about once every 5-10 minutes throughout the day, yesterday and today they’ve been virtually gone. For reference, I’m 35, very fit, and have no known history of heart disease in my family but I do seem to have high blood pressure, which is a second thing I’m trying to figure out with the doctor.

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I have had high blood pressure when I tried some anti depressants. It was the most unpleasant feeling as my heart felt like it was beating so hard it was going to jump out of my chest.

I too have had episodes of being aware of my heart beating when lying in bed. I feel like I can almost hear it beating and feel each beat. It is not racing but just beating intensely. I too have been limiting my intensity doing more endurance rides. One thing I have noticed changing is that I am finding it harder to do longer intervals above threshold, 5-10 minutes but I can still do a good number of shorter more intense intervals like 30 seconds on 30 seconds off. I have wondered about alcohol. I have started tracking my consumption to see if there is any correlation. My caffeine consumption has been pretty steady over the years to 2 cups a day. I drink plenty of water and always have a pint glass on my desk. I even tried the “drink a gallon a day” for a bit. My mom’s side of the family have had heart issues and she has atrial fibrillation and my dad died of heart failure (although I was told it is not hereditary and he was just unlucky). I seem to have exercised induced high blood pressure. ie it is normal at rest but becomes elevated when I exercise hard. But the cardiologist said that because I am capable of going pretty hard he is not surprised to see blood pressure elevated and he didn’t seem concerned about it.

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Statins are a mitochondrial toxin. The mevalonate pathway, which statins inhibit, feeds into the coq10 production that mitochondria need to run the electron transport chain properly. This is very “well known” (seriously, lots of pubmed papers), but many doctors don’t know about it, and those that do will tell you it’s worth the tradeoff for cvd outcomes. Coq10 is not the only casualty… just the one we have a supplement for.

I really liked this presentation on the topic (more chemistry than sports performance, but it paints a picture)

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I had a heart attack at 30 playing football and was playing a very good level and was told to take up another sport for recovery and the rest is now history .

Over the last 12 years I have had several scans , in fact more than I can count and was told I was just unlucky but have a history in the family from my maternal side and high cholesterol. I have been on Statins all the time a long with beta blockers due to the damage to my heart.

I started racing 2 years ago in the UK and the first season was a rude awakening but the second year after training properly I got my Cat 3 in very few races .

I have times when I can hear every heart beat at times like you have mentioned and at first it was a bit odd but over the years have learnt to listen to my body a lot more and respond to what it is telling me and change the training accordingly. its weird but I feel its like you become more aware or in in tune with your body. I also worked out that my body responds better to high intensity training and get better responses personally .

My point is get the all clear from the doctor/ cardiologist but also ask the cardiologist about the training you can do , mine was a runner and the rehab nurse was a cyclist and they always gave me sound advice. You can get several peoples opinions but make sure you listen to the medical people . Once you have the all clear work out what works for you and work your training around that -stay positive and have faith !

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@SeanHurley
I had a number of PVC’s for a few months before this winter started. It gave me a TON of anxiety, and they manifested themselves as described above (one heavy heartbeat, felt like it would take my breath away). I went to the ER when it started and they said I was fine, that I was having a panic attack.

Followed up with my family doc and she gave me an ECG, it looked good but she referred me to a cardiologist. Cardiologist gave me a stress test, ECG, and ultrasound of my heart. These tests all looked good (albeit my blood pressure was high, but I get nervous around doctors). I came back for a 48hr Holter monitor and they could see that I had an abnormal amount of PVC’s.

They suggested I take a low dose beta blocker to see if that helped. They also reassured me that the PVC’s were benign, they did not mean I was in a life threatening situation. I took the beta blocker for a week. It made me feel more relaxed, but only had minimal improvement on PVCs. I quit taking them because they lowered my max HR.

Ultimately the PVC’s vanished just as oddly as they came. I work in a very stressful industry, long hours, switching between night shift and day shift. I started meditating. I tried to learn to control my stress and anxiety with self help books. I made sleep a priority, and tried to get a minimum of 8hrs/day. I changed my diet to primarily whole foods based. I didn’t drink too often to begin with, but I did stop drinking. I lowered my training load as well. These changes, in my situation, led to the PVCs going away. It seemed like they left gradually.

Working out had always been my outlet for stress, but I think finding other ways to relax really helped my PVC situation. I will say I noticed my PVC’s got worse on night shift, and prioritizing sleep made a big difference. My PVC’s are non-existent at this point, although when in stressful situations sometimes my chest feels tight (anxiety). I do drink occasionally now. I am a 25 y/o male, 6’4 220lbs with no immediate family history of heart disease. I have 2 uncles who have smoked all of their lives; they had heart attacks around age 60. My parents are perfectly healthy with no heart issues. Try not to stress!

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I very much appreciate you guys chiming in with your experiences. I’m back to training, albeit still haven’t done any maximal efforts. Both EKG and 24h halter qualified as normal. Turns out I’m only having a few PVCs each day, I’m also having a few instances of PSVT, which is usually an extended elevated rhythm. For me, I’ve never had an elevated rhythm, so best I can understand it’s just periodic, momentary instances of it. Interesting enough, the worst “attack” that I had while on the halter, which I indicated with the button you press to leave a bookmark in the data, turned out to be a completely normal rhythm, so a lot of what I’m feeling is likely to be anxiety-related, and probably not physical at all. I had an ultrasound two days ago ( insurance wouldn’t approve a stress test since everything else is completely normal) and pending results of that I’ll get back to training completely normally. I’ve been reintroducing sweet spot since my halter test came back ok and have felt totally fine. For me, it seems this really is related more to anxiety and a concern about the heart that turns into a fear spiral, than it is about an actual physical cause. I’m now in the process of trying to rewire my gut reaction to hard efforts back to one of self-motivation, from the new fear response I’ve developed through this ordeal. And since I stopped worrying about this, I almost entirely stopped noticing it at all- I’m now feeling it just a few times during the day and not paying it any attention. I also started taking magnesium several weeks ago just to see if it’d help. I don’t know whether it has or hasn’t, but I haven’t had any gastrointestinal issues so I’ll continue with it for the time being.

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