Answer: A. Higher
Serum statin levels are often higher in Asians compared to whites, because of genetic differences in the expression of membrane transporter proteins that play a role in statin metabolism. In particular, the FDA has cautioned against treating Chinese patients with simvastatin doses higher than 20 mg/day, when combined with niacin. Rosuvastatin labeling also includes information about higher blood levels of statins in Asians. Labeling for pitavastatin, atorvastatin and fluvastatin does not include a special population warning for Asians. However, experts recommend starting Asians and Asian-Americans on low doses of all statins.1
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1. Kellick KA, Bottorff M, Toth PP, The National Lipid Association's Safety Task Force. A clinician's guide to statin drug-drug interactions. J Clin Lipidol. 2014;8:S30-46.
2. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2013;63:2889-2934.
3. US Food and Drug Administration. FDA Drug Safety Communication: interaction between certain HIV or hepatitis C drugs and cholesterol-lowering statin drugs can increase the risk of muscle injury. http://www.fda.gov/Drugs/DrugSafety/ucm293877.htm. Published March 1, 2012. Acessed May 8, 2018.
4. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. US Department of Health and Human Services. Available at https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl003093.pdf. Accessed May 18, 2018.