Response to the letter “No evidence to support high-intensity statin in Chinese patients with coronary heart disease”

We agree with Dai and colleagues that high-intensity statin treatment should be avoided or used with more caution in Chinese patients because of ethnic differences in pharmacokinetics but we think the available data does not support their conclusion that more intensive treatment would not have a greater benefit in some Chinese patients [ [1] Dai W. Huang X.S. Zhao S.P. No evidence to support high-intensity statin in Chinese patients with coronary heart disease. Int. J. Cardiol. 2015; 204: 57-58 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar ]. Plasma concentrations of rosuvastatin are on average twice as high in Chinese and Japanese subjects compared with Caucasians and this resulted in a warning in the product label that Asian patients should start with the lower dose of 5-mg once daily. Although the label does not indicate the maximum dose should be less in Asians than Caucasians, we normally restrict the dose to 20-mg daily in Chinese patients as this would result in the same average systemic exposure as the maximum approved dose of 40-mg in Caucasians. In Japan, the maximum approved dose of rosuvastatin is 20-mg daily and the maximum approved doses of other statins are also lower than those in Western countries [ [2] Malinowski H.J. Westelinck A. Sato J. Ong T. Same drug, different dosing: differences in dosing for drugs approved in the United States, Europe, and Japan. J. Clin. Pharmacol. 2008; 48: 900-908 Crossref PubMed Scopus (65) Google Scholar ].