Several studies have reported the effects of gait speed and balance on hypertension, cerebrovascular, and cardiovascular diseases (Fig. 1; top right-pointing arrow). According to a 4-year follow-up of 2733 older Chinese adults with objectively measured walking speeds, the faster the walking speed, the lower the risk of developing hypertension [1]. This association was evident in obese individuals but not thin ones [1]. A causal analysis using Mendelian randomization in a sample of 340,000 participants of European ancestry from the UK Biobank showed that a faster habitual walking pace had a protective effect on cardiovascular disease risk [2]. This protective effect was 45% mediated through body mass index [2]. Conversely, hypertension and lipid abnormalities may affect walking speed and balance (Fig. 1, bottom left arrow). The results of a cross-sectional study of 268 patients with vascular risk factors but without Parkinsonism or dementia showed significantly higher rates of gait and balance impairment in patients with lacunar infarctions, periventricular hyperintensities, white matter hyperintensities, and microcerebrovascular disease [3], suggesting that hypertension and lipid abnormalities may affect gait and balance impairments via microcerebrovascular disorders.

Fig. 1
figure 1

Relationship between gait stability or balance function and hypertension or dyslipidemia

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There is a discussion on whether statins should be used cautiously, given their potential to decrease stability and increase the ultimate risk of falls and fractures. To determine whether statin use is associated with a reduced balance ability in older patients, an observational study in which statin use (n = 34) and non-statin use (n = 31) groups underwent balance assessment with closed and open eyes on a pressure-sensing MatScan showed that statin users had significantly higher amplitude and velocity of mediolateral sway in the open-eye state than non-statin users after adjusting for confounders [4]. In a study examining high fall-risk drugs among 345 community-dwelling older adults aged 65 years and older, statin use was associated with a significant increase in stride time variability for a marker of gait variability [5]. In older patients with polypharmacy and multiple comorbidities, statin-related muscle symptoms may have clinical significance even at low grades. Moreover, physical performance and muscle function between statin users and non-users in 174 patients aged 70 years and older, not expected to die or be institutionalized within 6 months, and receiving treatment with at least seven regular systemic drugs were compared [6]. Compared with non-users, statin users’ physical and muscle functions improved slightly, and Short Physical Performance Battery scores and walking speed increased with increasing statin use, contrary to this hypothesis [6].

The effect of hypertension and dyslipidemia interventions on improving gait speed and balance remains unclear. Intensive blood pressure treatment with a target systolic blood pressure of less than 120 mmHg did not affect the walking speed, and it was not associated with a change in limitation of movement compared with treatment with a target systolic blood pressure of less than 140 mmHg among 2636 hypertensive patients aged ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT) [7]. The Senior Project Intensive Training (SPRINT) study, an entirely different study using the same abbreviations as in the previous study, sub-analyzed whether statins or antihypertensives may influence participants’ responses to strength training among 179 patients aged ≥65 years and revealed that 6 weeks of training significantly improved muscle strength and performance, regardless of antihypertensive or statin use [8]. A recent systematic review of 20 articles on the statin effect for falls and physical activity in individuals 65 years or older also found no relationship between statin use and physical activity or fall risk [9].

In this study [10], Ge et al. examined whether rosuvastatin was associated with improvements in gait and balance impairment in a 2 × 2 factorial randomized intervention study of 943 patients with hypertension aged 60 years and older. The main objective of the original study was to examine the interaction between telmisartan and rosuvastatin in reducing the risk of cardiovascular events in patients with hypertension. A Biodex Gait Trainer-3 handrail treadmill was used to determine the left-right differences related to gait. Compared with the placebo group, gait and balance improved significantly in the rosuvastatin group, with a decreased risk of balance impairment and falls. In addition, cerebrovascular reactivity improved significantly in the rosuvastatin group compared with the placebo group, and the risk of cerebrovascular reactivity impairment decreased. Furthermore, improvements in gait and balance were closely associated with improvements in cerebrovascular reactivity, independent of the intima-media thickness of the common carotid artery and changes in plasma lipids, blood pressure, and fasting plasma glucose during the follow-up period.

The effects of statins and antihypertensive therapy on gait and balance are difficult to measure because of various confounding factors. Although our study was independent of changes in fasting blood glucose levels, further investigations regarding the effects of history of diabetes, hypoglycemia, and other factors are necessary. Meanwhile, the outcomes observed in this intervention study are likely to have limited confounding effects, and a large population may benefit positively; further careful study, including consideration of extrapolability, will be necessary to determine the preventive effects.