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Statin Effects on LDL and HDL Cholesterol in South Asian and White Populations

From the Division of Cardiology, William Osler Health Centre, Canada (Dr Gupta, Ms Tsigoulis); Department of Medicine, McMaster University, Canada (Dr Gupta); Division of Cardiovascular and Thoracic Surgery (Dr Gupta, Dr Teoh, Dr Verma), Cardiometabolic Risk Initiative (Dr Gupta, Dr Braga, Dr Teoh, Dr Verma), St. Michael's Hospital, Toronto, Ontario, Canada; and Canadian Cardiovascular Research Network, Brampton, Ontario, Canada (Dr Gupta, Dr Teoh, Ms Tsigoulis, Dr Verma).

Inasmuch as statins appear to exhibit altered efficacy in some Asian populations (predominantly East Asian), current lipid guidelines recommend the use of lower statin doses in all Asians. Whether this should also apply to South Asians, a population at high risk for coronary heart disease, remains unclear. The authors evaluated the lipid-modifying effects of statins in South Asian and white patients with established coronary heart disease. Atorvastatin (median dose = 20 mg/d in both groups) produced similar decreases in low-density lipoprotein cholesterol (LDL-c) in South Asian (43%) and white (41%) patients and raised high-density lipoprotein cholesterol (HDL-c) by 19% in South Asians and by 12% in whites. Simvastatin (median dose = 20 mg/d in both groups) reduced LDL-c by 35% in South Asians and by 37% in whites while raising HDL-c by 12% in both groups. Using a multiple linear regression model (atorvastatin equivalent), the expected decrease in LDL-c for 10 mg atorvastatin and 20 mg atorvastatin was similar between the groups. Results indicate that atorvastatin and simvastatin, at commonly prescribed doses, modulate LDL-c and HDL-c levels to a similar degree in both South Asians and whites with documented coronary heart disease. These findings suggest that South Asian patients may be treated with atorvastatin and simvastatin at doses typically applied to white patients.

Key Words: South Asian • coronary heart disease • statins • LDL cholesterol

Address for reprints: Milan Gupta, MD, Division of Cardiology, William Osler Health Centre, McMaster University, 3 Conestoga Drive, Brampton, Ontario, Canada L6Z 4N5; e-mail: mkgupta{at}rogers.com.

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