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JESSICA C. SONG, M.A., PHARM.D., is Assistant Professor, University of the Pacific School of Pharmacy (UPSP), Stockton, CA, and Pharmacy Residency Coordinator, Department of Pharmacy, Santa Clara Valley Medical Center (SCVMC), San Jose, CA. CLIFFORD C. WANG, M.D., is Chief, Division of Primary Care, Inpatient Medicine Section, Department of Medicine, SCVMC, and Clinical Assistant Professor, Stanford University School of Medicine (SUSM), Stanford, CA. YI-CHAO HUANG, M.D., is Assistant Chief, Division of Primary Care, Department of Medicine, SCVMC, and Clinical Instructor, SUSM. JEANNETTE SANCHEZ, PHARM.D., is Pharmacist; and THERESA NGUYEN, PHARM.D., is Pharmacy Practice Resident, Department of Pharmacy Services, Kaiser Permanente Medical Center, Santa Clara, CA. SHAMIMA KHAN, PH.D., is Assistant Professor, Pharmacy Practice, College of Pharmacy, North Dakota State University, Fargo. MYO-KYOUNG KIM, PHARM.D., is Assistant Professor, Pharmacy Practice, UPSP. PHOEBE LI, PHARM.D., is Assistant Director, Outpatient Pharmacy Services, SCVMC.

Address correspondence to Dr. Song at the Department of Pharmacy, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128 (jessica.song{at}hhs.co.santa-clara.ca.us).

Purpose. 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. Conclusion. 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. Index terms: Antilipemic agents; Atorvastatin; Coronary disease; Dosage; Drug interactions; Ethnic groups; Gemfibrozil; Simvastatin; Toxicity