Case report of exercise and statin-fibrate combination therapy-caused myopathy in a patient with metabolic syndrome: contradictions between the two main therapeutic pathways

We present a case of a 43-year-old Caucasian man with metabolic syndrome who had the side-effect of exercise and drug-associated myositis. The patient had only transient moderate complaints and rhabdomyolysis could be avoided with the one-month creatine kinase control, a test which is not recommended routinely by the new guidelines.We would like to turn the spotlight on the possible complications of statin-fibrate therapy and exercise, when strict follow-up is recommended. In this condition high number of patients can be affected and the responsibility of general practitioners is accentuated.Cardiovascular disease is the leading cause of death in developed countries. In adults besides body mass index above 30 kg/m2 or elevated waist circumference, the clustered presence of 2 or more cardiovascular risk factors from among high triglyceride and fasting blood glucose levels, low high-density lipoprotein cholesterol (HDL-C), raised blood pressure and the presence of treated hypertension or type 2 diabetes has been designated the “metabolic syndrome” (MetS) [1]. These components are the principal risk factors in the development of atherosclerosis and cardiovascular disease. Related to this high risk status, the treatment of patients with MetS is an important task of the basic healthcare.There is substantial evidence that regular exercise has beneficial effects in physical and mental health and contributes to the primary and secondary prevention of cardiovascular and several chronic diseases, like breast and colon cancer or diabetes [2]. Exercise improves a variety of lipid and lipoprotein variables [3] and is a fundamental part of the therapy of MetS.The alternative of the lifestyle modifications is the use of tablets. For the correction of lipid disorders in MetS, recommendations, like the recent European guideline (European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS 2011) [4]) aims a certain level of serum lipids. Not only statin or fibrate