Dear Dr. Roach: I am a 65-year-old man. In May 2023, I had a major heart attack. Three stents were installed. I have been doing well since the heart attack, except I now get bone and joint pain and aches. I have lost 85 pounds. My blood pressure is very good now, as is my cholesterol. My primary doctor advised me that 70 mg/dL is in the more normal range. My A1C is now a consistent 6.2%, down from 8.2%. I am on a strict fat-free diet, and I watch my fat and carb intake very carefully.
My problem is the bone pain and aches in my joints and muscles. My cardiologist suggested that I take a week off from my cholesterol medicine (80 mg of atorvastatin). So far, this has not helped at all. I also take 90 mg of Brilinta twice daily, but my cardiologist said that I will no longer need Brilinta after the upcoming one-year anniversary of my heart attack. I also take losartan, metoprolol, Jardiance, metformin and aspirin.
I did not have joint and muscle pain at first. As I have been taking the meds on a regular basis, I started having these problems within the last month or so.
Do you think any of the meds are causing the problem? If so, which one should I suspect? Do I need all of these medications now?
J.C.
Muscle aches are most common with statin drugs, such as the atorvastatin you are taking, which is why your cardiologist recommended holding it for a week. Unfortunately, a week might not be enough to see if that stops the muscle aches. (I usually hold it for four weeks to see whether the symptoms go away.)
However, you are also describing bone and joint aches, which is not how most people describe the pain from statins. Also, the fact that the symptoms started nearly a year after starting the medicine makes statin-associated muscle pain less likely.
Most muscle pain attributed to statins turns out not to be from statins, based on some very elegant studies. Because statins have a significant impact on reducing another heart attack after the first one, it is best not to completely stop the treatment, if possible. Your doctor might consider stopping it for a longer time and starting a different statin to see if that helps.
Although some experts try coenzyme Q10, the evidence suggests that it is no better than a placebo at improving muscle symptoms.
Losartan, metoprolol and aspirin are used in most people after a heart attack, as they provide significant benefit in preventing further episodes. Brilinta is usually used for at least a year after a heart attack, with some experts continuing the medication for up to three years in total.
As far as your diabetes treatment, in a large study, an A1C goal of 6% led to worse outcomes than an A1C goal of 7% in people at a high risk for heart disease. You may not need as much medication for your diabetes. You should talk to the clinician who is prescribing Jardiance and metformin about possibly lowering the doses or stopping one. Your diet must have made a big improvement.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
