title: Use of maximum-dose simvastatin or atorvastatin in an ethnically diverse population.
abstract: OBJECTIVE
  The use of maximum-dose simvastatin or atorvastatin in an ethnically diverse population was studied.
  
  
  METHODS
  This retrospective analysis was conducted at a publicly funded teaching institution whose predominant patient population consists of Hispanics and Asians. A computer-generated report was used to identify outpatients who received a prescription for maximum-dose simvastatin or atorvastatin between January 1, 2002, and January 1, 2004. Data evaluated included demographic information; metabolic syndrome elements; coronary heart disease (CHD) risk equivalents; clinical characteristics placing patients at very high risk of having a CHD event; 10-year Framingham risk score; documentation of hepatotoxicity, myalgia, myositis, or rhabdomyolysis during maximum-dose therapy; concomitant medication during maximumdose therapy; relevant laboratory test values; and physician response to biochemical abnormalities or adverse events associated with maximum-dose therapy.
  
  
  RESULTS
  Of the 232 outpatients identified, 173 were eligible for study inclusion. A total of 135 patients were classified as having a high or very-high risk of developing CHD (68 and 67, respectively). The success rates for low-density-lipoprotein (LDL) cholesterol goal attainment by very-high-risk patients and high-risk patients were 19.4% and 44.1%, respectively. Thirteen patients developed myalgia. Alanine transaminase levels were monitored for 38.8% of the study patients. Approximately 9% of patients were prescribed one interacting medication while on maximum-dose simvastatin or atorvastatin. The most commonly prescribed interacting drug was gemfibrozil.
  
  
  CONCLUSIONS
  Despite the use of maximum-dose simvastatin or atorvastatin, target LDL cholesterol goals were not achieved and statin use was not adequately monitored in an ethnically diverse population with a high or very high risk of developing CHD.
authors: University of the Pacific School of Pharmacy, Stockton, CA, USA. jessica.song@hhs.co.santa-clara.ca.us
authors: Jessica C
authors: JC
authors: Song
authors: Clifford C
authors: CC
authors: Wang
authors: Yi-Chao
authors: YC
authors: Huang
authors: Jeannette
authors: J
authors: Sanchez
authors: Theresa
authors: T
authors: Nguyen
authors: Shamima
authors: S
authors: Khan
authors: Myo-Kyoung
authors: MK
authors: Kim
authors: Phoebe
authors: P
authors: Li
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D002140:California; D004347:Drug Interactions; D005006:Ethnicity; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D011758:Pyrroles / Q000008:administration & dosage*; D012189:Retrospective Studies; D019821:Simvastatin / Q000008:administration & dosage*
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin