Statin Chest Pain

[Fonzo]

after an angiogram last September which showed clear the cardiologist instructed me to come off pre-cautionary nitrates and I was told to stay on 40mg Atorvastatin and commence Diltiazem 2 x 60mg per day as well as one Aspirin 75mg. Although not tested cardiologist thinks I have Microvascular angina (but doesn’t seem willing to carry out further investigations to confirm this?!). In any case I started to get a sharp stabbing pain in my upper left chest (comes only mostly at rest or when asleep) which decreases in severity when I move position. Lately this is really getting me down as I can feel it more regularly and pain radiates to my shoulder. It should be pointed out my BP, heart rate and ECG look normal for me during these episodes). It seems to have gotten worse after I stopped PPI esomeprazole which I had been taking for last 12 months. I recently attended Doctors as I had read Diltiazem can enhance the effectiveness of Atorvastatin. She agreed I should drop my dose from 40mg to 20mg Atorvastatin and monitor. No change still tight chest with stabbing pain. I am wondering if I have statin associated Fibromyalgia or some sort of myalgia. I occasionally use GTN spray but can’t say it has much effect. I am 56 yrs old, non-smoker, weight ok and I walk 5-6 miles a day. The statin was started as my cholesterol was high ;always has been and LDL was well over 3 mmol/l. I started a lower fat diet some time ago and am wondering if I should stop the statin for a period of time to see if chest pain (tender and painful to prod btw when it happens) goes away? Any similar cases out there?

[Hidden]

Statins has been prescribed for a long term reason, which is to lower your cholesterol and stabilise any arterial plaque, and it is unlikely that changing the dose or stopping the statin will affect your chest pains. A more likely reason for your chest discomfort is gastro rather than cardio related since you report your GTN spray has little effect and stopping the PPI has made matters worse. But that is only my view, and so my advice is to go and talk to your GP who will be able to offer a professional diagnosis. That is what GPs are there for.

[Fonzo in reply to Hidden]

Thanks for the advice and I am not discounting Gastro. But as I said the sharp stabbing pain in chest and shoulder has been prevalent for months and since I started Atorvastatin. There is lots of evidence of myopathy associated with the use of statins. I also think most doctors aren’t specialists in this area and that they need challenging - after all it’s not their body or well-being on the line.

[Hidden in reply to Fonzo]

I do agree that the diagnosis of a GP should be challenged if that does not sit well with you since they are by definition General Practitioners not specialists (although some GPs may have a medical specialism). However you are far more likely to get a correct diagnosis from a GP given their background rather than the views or speculations of someone on here since most are only here because of their own medical issues and not for a professional reason, and I do include myself in this. And if a GP is not sure they should send you on to someone who may have a better understanding of a condition as presented ,and that is part of the dialogue that you have with the GP.

[Milkfairy Heart Star]

Hello,I am sorry you are living with pain too.

I have lived with vasospastic angina for over 10 years. Vasospastic angina along with microvascular angina are types of non obstructive coronary artery disease NOCAD.

I experience most of my chest pain at rest especially at night between midnight and 6am. This is a common symptom of vasospastic angina.

I am on statins even though my cholesterol isn't raised. One of the possible causes of NOCAD is when the inner lining of the blood vessels doesn't work properly, endothelial dysfunction. Statins help to reduce endothelial dysfunction.

The symptoms of microvascular and vasospastic angina can overlap. It's important to get an accurlate diagnosis as the treatment options are different for microvascular and vasospastic angina.

There is growing evidence that nitrates are not as effective in patients with microvascular angina whilst they are with calcium channel blockers the mainstay of treatment for vasospastic angina .

I suggest you ask to be referred to a Cardiologist who has some understanding of microvascular and vasospastic angina.

NOCAD is a complex heart condition and requires the input of a knowledgeable Cardiologist.

More centres are now carrying out the appropriate testing to confirm whether a person has microvascular or vasospastic angina.

There are also several studies taking place into microvascular and vasospastic angina.

Perhaps discuss these with your Cardiologist and ask to be able to participate if that is what you would like to do.

clinicaltrials.gov/ct2/show...

isrctn.com/ISRCTN94728379