Lesser of evils for coronary artery

Dear Dr. Roach: I’m an 85-year-old woman. I’ve been on simvastatin for 15 years due to coronary artery disease. Two months ago, I developed a strong muscle pain in both legs. My doctor stopped the simvastatin and said to wait two weeks then start Crestor. The pain decreased when I stopped, but began to return. My doctor then stopped the Crestor and said to start Zetia. I am reluctant. Should I try CoQ10? — L.S.

Plenty of people get muscle aches when taking statin drugs. Most cases begin within six months of starting therapy. Although it’s not impossible that the simvastatin caused the muscle pain, it is substantially less likely than if it had started within a few weeks. A blood test for muscle breakdown (the CPK level) should be done to evaluate for a rare but very serious adverse reaction of rhabdomyolysis.

Low thyroid levels and vitamin D deficiency are risk factors for developing muscle aches, even without statins, but particularly in combination. I’d recommend checking for those.

Pain in the legs that gets worse with exercise in a person with known blockages in the heart makes me wonder about blockages in the blood vessels of the legs. These blockages can cause claudication, which is a muscle pain. A simple ultrasound test can evaluate this possibility.

If no other cause can be found, changing to a different type of statin is a good idea. Most experts would try pravastatin or fluvastatin. These are the least likely to cause muscle aches. Other experts will try Crestor every other day. CoQ10 anecdotally helps some people.

If a person cannot tolerate any statin, ezetimibe (Zetia) is a reasonable choice. It reduces cholesterol absorption. While some people have developed muscle pain with Zetia alone, the reported rates for pain suggest very little risk.