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Jiang S, Venners SA, Li K, Hsu YH, Weinstock J, Zou Y, Pan F, Xu X. Effect modification by region in the associations of LEP G2548A and LEPR Q223R polymorphisms with statin-induced CK elevation. Oncotarget 2017; 8:107565-107576. [PMID: 29296187 PMCID: PMC5746089 DOI: 10.18632/oncotarget.22506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/28/2017] [Indexed: 11/25/2022] Open
Abstract
We investigated the associations of LEP G2548A and LEPR Q223R polymorphisms with statin-induced creatine kinase (CK) elevation among Chinese patients with hyperlipidemia. A total of587 enrolled individuals were treated with 20 mg/d oral simvastatin for 8 consecutive weeks. Genotyping of LEP G2548A and LEPR Q223R were conducted using PCR-RFLP. Multiple regression analyses showed that, in the Dongzhi region only, patients carrying the LEP AA genotype had a significantly greater increase in CK levels compared to those carrying the AG+GG genotypes after four weeks (P = 0.004) and eight weeks (P < 0.001) consecutive simvastatin treatment. Patients were further divided into three groups based on the tertiles of the CK distribution. Compared to subjects in the lowest tertile of CK elevation, the adjusted relative odds of having the AG+GG genotypes among subjects in the highest tertile was 0.5 (95% CI, 0.3 to 0.7) and 0.4 (95% CI, 0.2 to 0.6) after the fourth and eighth weeks, respectively. The interaction terms between the Beijing or Dongzhi region and the LEP GA+AA genotypes were marginally significant for CK elevation at the fourth week (P = 0.057) and significant for CK elevation at the eighth week (P = 0.002). The adverse effect of the LEP G2548A polymorphism on increasing CK levels may be dependent on the environmental milieu. It suggests that lifestyle interventions might offset the side effects of simvastatin therapy among those with genetic susceptibility. Further research is needed to identify specific individual-level factors for clinical practice that modify the effect of genotype.
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Affiliation(s)
- Shanqun Jiang
- School of Life Sciences, Anhui University, Hefei, China.,Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Scott A Venners
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kang Li
- School of Life Sciences, Anhui University, Hefei, China
| | - Yi-Hsiang Hsu
- Institute for Aging Research, HSL and Harvard Medical School, Boston, MA, USA.,Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, USA
| | - Justin Weinstock
- Department of Statistics, University of Virginia, Charlottesville, VA, USA
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiping Xu
- Institute of Biomedicine, Anhui Medical University, Hefei, China.,Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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Bakar NS, Neely D, Avery P, Brown C, Daly AK, Kamali F. Genetic and Clinical Factors Are Associated With Statin-Related Myotoxicity of Moderate Severity: A Case-Control Study. Clin Pharmacol Ther 2017; 104:178-187. [PMID: 28940218 DOI: 10.1002/cpt.887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 01/04/2023]
Abstract
We evaluated the contribution of patient-specific clinical and genetic factors to statin-related muscle toxicity (SRM) without a significant creatine kinase elevation (125 cases related to simvastatin or atorvastatin and 481 controls). The association between 12 single nucleotide polymorphisms (SNPs) in nine candidate genes and clinical factors with SRM was evaluated. Of the 12 SNPs genotyped, only rs4149056 in SLCO1B1 was associated with SRM in univariate analysis (with any statin, odd ratio (OR) = 1.73, 95% confidence interval (CI) = 1.14-2.62, P = 0.010) and this association was influenced by sex (P = 0.006) and BMI (P = 0.02). In multivariate and binary logistic regression analyses, SLCO1B1 rs4149056 genotype (OR = 1.66, 95% CI: 1.08-2.54, P = 0.014) and sex (OR = 1.72, 95% CI = 1.15-2.59, P = 0.006) were independently associated with muscle toxicity related to statin treatment. Patient-specific genetic and clinical factors associated with increased systemic exposure to statins are implicated in the full spectrum of SRM, including myalgia in addition to severe myopathy.
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Affiliation(s)
| | - Dermot Neely
- Department of Clinical Biochemistry, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle, UK
| | - Peter Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle, UK
| | - Colin Brown
- Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Ann K Daly
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Farhad Kamali
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
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Abstract
PURPOSE OF REVIEW Pharmacogenetics is an important component of precision medicine. Even within the genomic era, several challenges lie ahead in the road towards clinical implementation of pharmacogenetics in the clinic. This review will summarize the current state of knowledge regarding pharmacogenetics of cardiovascular drugs, focusing on those with the most evidence supporting clinical implementation- clopidogrel, warfarin and simvastatin. RECENT FINDINGS There is limited translation of pharmacogenetics into clinical practice primarily due to the absence of outcomes data from prospective, randomized, genotype-directed clinical trials. There are several ongoing randomized controlled trials that will provide some answers as to the clinical utility of genotype-directed strategies. Several academic medical centers have pushed towards clinical implementation where the clinical validity data are strong. Their experiences will inform operational requirements of a clinical pharmacogenetics testing including the timing of testing, incorporation of test results into the electronic health record, reimbursement and ethical issues. SUMMARY Pharmacogenetics of clopidogrel, warfarin and simvastatin are three examples where pharmacogenetics testing may provide added clinical value. Continued accumulation of evidence surrounding clinical utility of pharmacogenetics markers is imperative as this will inform reimbursement policy and drive adoption of pharamcogenetics into routine care.
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Affiliation(s)
- Sony Tuteja
- Department of Medicine, University of Pennsylvania Perelman School of Medicine
| | - Nita Limdi
- Department of Neurology, University of Alabama at Birmingham
- Hugh Kaul Personalized Medicine Institute
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Exploration des myopathies toxiques : de l’anamnèse aux méthodes de pharmacogénomique. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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55
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Rosenson RS, Baker S, Banach M, Borow KM, Braun LT, Bruckert E, Brunham LR, Catapano AL, Elam MB, Mancini GJ, Moriarty PM, Morris PB, Muntner P, Ray KK, Stroes ES, Taylor BA, Taylor VH, Watts GF, Thompson PD. Optimizing Cholesterol Treatment in Patients With Muscle Complaints. J Am Coll Cardiol 2017; 70:1290-1301. [DOI: 10.1016/j.jacc.2017.07.752] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/24/2022]
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Maxwell WD, Ramsey LB, Johnson SG, Moore KG, Shtutman M, Schoonover JH, Kawaguchi-Suzuki M. Impact of Pharmacogenetics on Efficacy and Safety of Statin Therapy for Dyslipidemia. Pharmacotherapy 2017; 37:1172-1190. [DOI: 10.1002/phar.1981] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Whitney D. Maxwell
- Department of Clinical Pharmacy and Outcomes Sciences; University of South Carolina College of Pharmacy; Columbia South Carolina
| | - Laura B. Ramsey
- Division of Research in Patient Services-Pharmacy Research; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Samuel G. Johnson
- American College of Clinical Pharmacy; Washington District of Columbia
- Virginia Commonwealth University; Richmond Virginia
| | - Kate G. Moore
- Department of Pharmacy Practice; Presbyterian College School of Pharmacy; Clinton South Carolina
| | - Michael Shtutman
- Department of Drug Discovery and Biomedical Sciences; University of South Carolina College of Pharmacy; Columbia South Carolina
| | - John H. Schoonover
- Department of Clinical Pharmacy and Outcomes Sciences; University of South Carolina College of Pharmacy; Columbia South Carolina
| | - Marina Kawaguchi-Suzuki
- School of Pharmacy; Pacific University College of Health Professions; Hillsboro Oregon
- Clinical Pharmacy Services; Kaiser Permanente Northwest; Portland Oregon
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Berinstein E, Levy A. Recent developments and future directions for the use of pharmacogenomics in cardiovascular disease treatments. Expert Opin Drug Metab Toxicol 2017; 13:973-983. [PMID: 28792790 DOI: 10.1080/17425255.2017.1363887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cardiovascular disease is still the leading cause of death worldwide. There are many environmental and genetic factors that play a role in the development of cardiovascular disease. The treatment of cardiovascular disease is beginning to move in the direction of personalized medicine by using biomarkers from the patient's genome to design more effective treatment plans. Pharmacogenomics have already uncovered many links between genetic variation and response of many different drugs. Areas covered: This article will focus on the main polymorphisms that impact the risk of adverse effects and response efficacy of statins, clopidogrel, aspirin, β-blockers, warfarin dalcetrapib and vitamin E. The genes discussed include SLCO1B1, ABCB1, CYP3A4, CYP3A5, CYP2C19, PTGS1, PTGS2, ADRB1, ADCY9, CYP2C19, PON1, CES1, PEAR1, GPIIIa, CYP2D6, CKORC1, CYP2C9 and Hp. Expert opinion: Although there are some convincing results that have already been incorporated in the labelling treatment guidelines, most gene-drug relationships have been inconsistent. A better understanding of the relationships between genetic factors and drug response will provide more opportunities for personalized diagnosis and treatment of cardiovascular disease.
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Affiliation(s)
- Elliot Berinstein
- a Technion Faculty of Medicine , Technion Israel Institute of Technology , Haifa , Israel
| | - Andrew Levy
- a Technion Faculty of Medicine , Technion Israel Institute of Technology , Haifa , Israel
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SLCO1B1 521T > C polymorphism associated with rosuvastatin-induced myotoxicity in Chinese coronary artery disease patients: a nested case–control study. Eur J Clin Pharmacol 2017; 73:1409-1416. [DOI: 10.1007/s00228-017-2318-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022]
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Elam MB, Majumdar G, Mozhui K, Gerling IC, Vera SR, Fish-Trotter H, Williams RW, Childress RD, Raghow R. Patients experiencing statin-induced myalgia exhibit a unique program of skeletal muscle gene expression following statin re-challenge. PLoS One 2017; 12:e0181308. [PMID: 28771594 PMCID: PMC5542661 DOI: 10.1371/journal.pone.0181308] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/29/2017] [Indexed: 01/21/2023] Open
Abstract
Statins, the 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase inhibitors, are widely prescribed for treatment of hypercholesterolemia. Although statins are generally well tolerated, up to ten percent of statin-treated patients experience myalgia symptoms, defined as muscle pain without elevated creatinine phosphokinase (CPK) levels. Myalgia is the most frequent reason for discontinuation of statin therapy. The mechanisms underlying statin myalgia are not clearly understood. To elucidate changes in gene expression associated with statin myalgia, we compared profiles of gene expression in skeletal muscle biopsies from patients with statin myalgia who were undergoing statin re-challenge (cases) versus those of statin-tolerant controls. A robust separation of case and control cohorts was revealed by Principal Component Analysis of differentially expressed genes (DEGs). To identify putative gene expression and metabolic pathways that may be perturbed in skeletal muscles of patients with statin myalgia, we subjected DEGs to Ingenuity Pathways (IPA) and DAVID (Database for Annotation, Visualization and Integrated Discovery) analyses. The most prominent pathways altered by statins included cellular stress, apoptosis, cell senescence and DNA repair (TP53, BARD1, Mre11 and RAD51); activation of pro-inflammatory immune response (CXCL12, CST5, POU2F1); protein catabolism, cholesterol biosynthesis, protein prenylation and RAS-GTPase activation (FDFT1, LSS, TP53, UBD, ATF2, H-ras). Based on these data we tentatively conclude that persistent myalgia in response to statins may emanate from cellular stress underpinned by mechanisms of post-inflammatory repair and regeneration. We also posit that this subset of individuals is genetically predisposed to eliciting altered statin metabolism and/or increased end-organ susceptibility that lead to a range of statin-induced myopathies. This mechanistic scenario is further bolstered by the discovery that a number of single nucleotide polymorphisms (e.g., SLCO1B1, SLCO2B1 and RYR2) associated with statin myalgia and myositis were observed with increased frequency among patients with statin myalgia.
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Affiliation(s)
- Marshall B. Elam
- Department of Veterans Affairs Medical Center-Memphis, Memphis, Tennessee, United States of America
- Department of Pharmacology, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
- * E-mail: (MBE); (RR)
| | - Gipsy Majumdar
- Department of Veterans Affairs Medical Center-Memphis, Memphis, Tennessee, United States of America
- Department of Pharmacology, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Khyobeni Mozhui
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Ivan C. Gerling
- Department of Veterans Affairs Medical Center-Memphis, Memphis, Tennessee, United States of America
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Santiago R. Vera
- Department of Veterans Affairs Medical Center-Memphis, Memphis, Tennessee, United States of America
| | - Hannah Fish-Trotter
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Robert W. Williams
- Department of Genetics, Genomics and Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Richard D. Childress
- Department of Veterans Affairs Medical Center-Memphis, Memphis, Tennessee, United States of America
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
| | - Rajendra Raghow
- Department of Veterans Affairs Medical Center-Memphis, Memphis, Tennessee, United States of America
- Department of Pharmacology, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States of America
- * E-mail: (MBE); (RR)
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61
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Priti K, Agrawal A, Ranwa BL. High versus low dose statin therapy in Indian patients with acute ST-segment elevation myocardial infarction undergoing thrombolysis. Indian Heart J 2017; 69:453-457. [PMID: 28822510 PMCID: PMC5560891 DOI: 10.1016/j.ihj.2017.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives This study sought to compare high dose versus low dose statin therapy in Indian patients with ST-segment elevation myocardial infarction (STEMI) undergoing thrombolysis. Background Randomized trials have demonstrated that statin treatment reduced major adverse cardiac events (MACEs) in patients with stable angina pectoris and acute coronary syndrome. However, randomized studies of statin therapy in Indian patients with STEMI are scarce. Methods Of 1859 patients with acute STEMI, 1027 eligible patients were randomized to 80-mg (n = 512) or 10-mg (n = 515) atorvastatin. Primary end point was 30-day incidence of MACE (death from any cause, myocardial infarction, NSTE-ACS requiring readmission, ischemia driven revascularization, and stroke). Secondary end points included individual components of primary end point and ST-segment resolution at 90 min after thrombolysis. Results Two groups did not differ in primary endpoints of MACEs (8.79% in high dose vs 9.32% in low dose atorvastatin group, OR = 0.938, 95% CI = 0.612–1.436, P = 0.764). With 80 mg atorvastatin, there was insignificant reduction in rate of reinfarction, revascularization and death. Stroke and readmission for NSTE-ACS increased in 80 mg atrovastatin group, but was not statistically significant. ST-segment resolution was significantly higher in 80-mg atorvastatin arm (45.90% vs. 37.67%; p = 0.008). Myalgia was more in 80 mg statin group (18.06% vs 7.57%, p = 0.0001). Conclusions High-dose atorvastatin did not show significant difference of MACEs in STEMI patients undergoing thrombolysis but showed significant improvement in immediate coronary flow depicted by ST-segment resolution. This benefit of high dose statin is to be weighed against greater myalgia, drug discontinuation and cost in Indian patients.
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Affiliation(s)
- K Priti
- Dept of cardiology, JLN hospital, Ajmer, Rajasthan, 305001, India.
| | - Anand Agrawal
- Dept of cardiology, JLN hospital, Ajmer, Rajasthan, 305001, India.
| | - Bhanwar L Ranwa
- Dept of cardiology, JLN hospital, Ajmer, Rajasthan, 305001, India.
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Arrigoni E, Del Re M, Fidilio L, Fogli S, Danesi R, Di Paolo A. Pharmacogenetic Foundations of Therapeutic Efficacy and Adverse Events of Statins. Int J Mol Sci 2017; 18:ijms18010104. [PMID: 28067828 PMCID: PMC5297738 DOI: 10.3390/ijms18010104] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 12/11/2022] Open
Abstract
Background: In the era of precision medicine, more attention is paid to the search for predictive markers of treatment efficacy and tolerability. Statins are one of the classes of drugs that could benefit from this approach because of their wide use and their incidence of adverse events. Methods: Literature from PubMed databases and bibliography from retrieved publications have been analyzed according to terms such as statins, pharmacogenetics, epigenetics, toxicity and drug–drug interaction, among others. The search was performed until 1 October 2016 for articles published in English language. Results: Several technical and methodological approaches have been adopted, including candidate gene and next generation sequencing (NGS) analyses, the latter being more robust and reliable. Among genes identified as possible predictive factors associated with statins toxicity, cytochrome P450 isoforms, transmembrane transporters and mitochondrial enzymes are the best characterized. Finally, the solute carrier organic anion transporter family member 1B1 (SLCO1B1) transporter seems to be the best target for future studies. Moreover, drug–drug interactions need to be considered for the best approach to personalized treatment. Conclusions: Pharmacogenetics of statins includes several possible genes and their polymorphisms, but muscular toxicities seem better related to SLCO1B1 variant alleles. Their analysis in the general population of patients taking statins could improve treatment adherence and efficacy; however, the cost–efficacy ratio should be carefully evaluated.
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Affiliation(s)
- Elena Arrigoni
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Marzia Del Re
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Leonardo Fidilio
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Stefano Fogli
- Department of Pharmacy, University of Pisa, Via Bonanno Pisano 6, 56126 Pisa, Italy.
| | - Romano Danesi
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
| | - Antonello Di Paolo
- Clinical Pharmacology and Pharmacogenetic Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 55, 56126 Pisa, Italy.
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Friede K, Li J, Voora D. Use of Pharmacogenetic Information in the Treatment of Cardiovascular Disease. Clin Chem 2017; 63:177-185. [DOI: 10.1373/clinchem.2016.255232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 01/26/2023]
Abstract
Abstract
BACKGROUND
In 1964, Robert A. O'Reilly's research group identified members of a family who required remarkably high warfarin doses (up to 145 mg/day, 20 times the average dose) to achieve appropriate anticoagulation. Since this time, pharmacogenetics has become a mainstay of cardiovascular science, and genetic variants have been implicated in several fundamental classes of medications used in cardiovascular medicine.
CONTENT
In this review, we discuss genetic variants that affect drug response to 3 classes of cardiovascular drugs: statins, platelet P2Y12 inhibitors, and anticoagulants. These genetic variations have pharmacodynamic and pharmacokinetic effects and have been shown to explain differences in drug response such as lipid lowering, prevention of cardiovascular disease, and prevention of stroke, as well as incidence of adverse events such as musculoskeletal side effects and bleeding. Several groups have begun to implement pharmacogenetics testing as part of routine clinical care with the goal of improving health outcomes. Such strategies identify both patients at increased risk of adverse outcomes and alternative strategies to mitigate this risk as well as patients with “normal” genotypes, who, armed with this information, may have increased confidence and adherence to prescribed medications. While much is known about the genetic variants that underlie these effects, translation of this knowledge into clinical practice has been hampered by difficulty in implementing cost-effective, point-of-care tools to improve physician decision-making as well as a lack of data, as of yet, demonstrating the efficacy of using genetic information to improve health.
SUMMARY
Many genetic variants that affect individual responses to drugs used in cardiovascular disease prevention and treatment have been described. Further study of these variants is needed before successful implementation into clinical practice.
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Affiliation(s)
| | - Josephine Li
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC
| | - Deepak Voora
- Department of Medicine and and
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC
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Kovacsics D, Patik I, Özvegy-Laczka C. The role of organic anion transporting polypeptides in drug absorption, distribution, excretion and drug-drug interactions. Expert Opin Drug Metab Toxicol 2016; 13:409-424. [PMID: 27783531 DOI: 10.1080/17425255.2017.1253679] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The in vivo fate and effectiveness of a drug depends highly on its absorption, distribution, metabolism, excretion and toxicity (ADME-Tox). Organic anion transporting polypeptides (OATPs) are membrane proteins involved in the cellular uptake of various organic compounds, including clinically used drugs. Since OATPs are significant players in drug absorption and distribution, modulation of OATP function via pharmacotherapy with OATP substrates/inhibitors, or modulation of their expression, affects drug pharmacokinetics. Given their cancer-specific expression, OATPs may also be considered anticancer drug targets. Areas covered: We describe the human OATP family, discussing clinically relevant consequences of altered OATP function. We offer a critical analysis of published data on the role of OATPs in ADME and in drug-drug interactions, especially focusing on OATP1A2, 1B1, 1B3 and 2B1. Expert opinion: Four members of the OATP family, 1A2, 1B1, 1B3 and 2B1, have been characterized in detail. As biochemical and pharmacological knowledge on the other OATPs is lacking, it seems timely to direct research efforts towards developing the experimental framework needed to investigate the transport mechanism and substrate specificity of the poorly described OATPs. In addition, elucidating the role of OATPs in tumor development and therapy response are critical avenues for further research.
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Affiliation(s)
- Daniella Kovacsics
- a Membrane protein research group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences , Budapest , Hungary
| | - Izabel Patik
- a Membrane protein research group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences , Budapest , Hungary
| | - Csilla Özvegy-Laczka
- a Membrane protein research group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences , Budapest , Hungary
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Singh K, Peyser B, Trujillo G, Milazzo N, Savard D, Haga SB, Musty M, Voora D. Rationale and design of the SLCO1B1 genotype guided statin therapy trial. Pharmacogenomics 2016; 17:1873-1880. [PMID: 27807988 DOI: 10.2217/pgs-2016-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Kavisha Singh
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Bruce Peyser
- Department of Medicine, Duke University, Durham, NC, USA
| | | | | | | | - Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Michael Musty
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
| | - Deepak Voora
- Center for Applied Genomics and Precision Medicine, Duke University, Durham, NC, USA
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Kitzmiller JP, Mikulik EB, Dauki AM, Murkherjee C, Luzum JA. Pharmacogenomics of statins: understanding susceptibility to adverse effects. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2016; 9:97-106. [PMID: 27757045 PMCID: PMC5055044 DOI: 10.2147/pgpm.s86013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Statins are a cornerstone of the pharmacologic treatment and prevention of atherosclerotic cardiovascular disease. Atherosclerotic disease is a predominant cause of mortality and morbidity worldwide. Statins are among the most commonly prescribed classes of medications, and their prescribing indications and target patient populations have been significantly expanded in the official guidelines recently published by the American and European expert panels. Adverse effects of statin pharmacotherapy, however, result in significant cost and morbidity and can lead to nonadherence and discontinuation of therapy. Statin-associated muscle symptoms occur in ~10% of patients on statins and constitute the most commonly reported adverse effect associated with statin pharmacotherapy. Substantial clinical and nonclinical research effort has been dedicated to determining whether genetics can provide meaningful insight regarding an individual patient’s risk of statin adverse effects. This contemporary review of the relevant clinical research on polymorphisms in several key genes that affect statin pharmacokinetics (eg, transporters and metabolizing enzymes), statin efficacy (eg, drug targets and pathways), and end-organ toxicity (eg, myopathy pathways) highlights several promising pharmacogenomic candidates. However, SLCO1B1 521C is currently the only clinically relevant pharmacogenetic test regarding statin toxicity, and its relevance is limited to simvastatin myopathy.
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Affiliation(s)
| | - Eduard B Mikulik
- Department of Biological Chemistry and Pharmacology, College of Medicine
| | - Anees M Dauki
- College of Pharmacy, The Ohio State University, Columbus, OH
| | | | - Jasmine A Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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Algharably EAH, Filler I, Rosenfeld S, Grabowski K, Kreutz R. Statin intolerance - a question of definition. Expert Opin Drug Saf 2016; 16:55-63. [PMID: 27645111 DOI: 10.1080/14740338.2017.1238898] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Statin therapy is the backbone of pharmacologic therapy for low-density lipoproteins cholesterol lowering and plays a pivotal role in cardiovascular disease prevention. Statin intolerance is understood as the inability to continue using a statin to reduce individual cardiovascular risk sufficiently, due to the development of symptoms or laboratory abnormalities attributable to the initiation or dose escalation of a statin. Muscle symptoms are the most common side effects observed. Areas covered: The main aim of this article is to present a review on published definitions of statin intolerance. In addition, a brief review on clinical aspects and risk factors of statin intolerance is provided and features for a common definition for statin intolerance are suggested. Expert opinion: A definition of statin intolerance by major drug regulatory agencies is not available. In clinical studies, different definitions are chosen and results are not comparable; different medical associations do not agree on one common definition. There is an unmet need to establish a common definition of statin intolerance to ensure an appropriate clinical use of this important drug class. Further work is required to develop a consensus definition on statin intolerance that could have significant positive impact on both research and clinical management.
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Affiliation(s)
- Engi Abdel-Hady Algharably
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany.,b Department of Clinical Pharmacy, Faculty of Pharmacy , Ain Shams University , Cairo , Egypt
| | - Iris Filler
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Stephanie Rosenfeld
- c Sanofi-Aventis Deutschland GmbH , Evidence Based Medicine , Berlin , Germany
| | - Katja Grabowski
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Reinhold Kreutz
- a Institut für Klinische Pharmakologie und Toxikologie , Charité - Universitätsmedizin Berlin , Berlin , Germany
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Jiang J, Tang Q, Feng J, Dai R, Wang Y, Yang Y, Tang X, Deng C, Zeng H, Zhao Y, Zhang F. Association between SLCO1B1 -521T>C and -388A>G polymorphisms and risk of statin-induced adverse drug reactions: A meta-analysis. SPRINGERPLUS 2016; 5:1368. [PMID: 27606156 PMCID: PMC4991977 DOI: 10.1186/s40064-016-2912-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/26/2016] [Indexed: 12/20/2022]
Abstract
An increasing number of studies have investigated the association between SLCO1B1 -521T>C and -388A>G polymorphisms and the risk of statin-induced adverse drug reactions (ADRs), but the results have been inconsistent. This meta-analysis was performed to gain more insight into the relationship. PubMed, Embase, Cochrane Library and Web of Science were searched for relevant articles published before March 5th, 2015. The quality of included studies was evaluated by the Newcastle-Ottawa Quality scale. Pooled effect estimates (odds ratios [ORs] or hazard ratios [HRs) and corresponding 95 % confidence intervals (CIs) were calculated to assess the association in overall and subgroup analyses for various genetic models. Begg's rank correlation test and Egger's linear regression test were used to examine the publication bias. A total of nine cohort and four case-control studies involving 11, 246 statin users, of whom 2, 355 developing ADRs were included in the analysis. Combined analysis revealed a significant association between the SLCO1B1-521T>C polymorphism and increased risk for ADRs caused by various statins, but the synthesis heterogeneity was generally large (dominant model: pooled effect estimate = 1.85, 95 % CI 1.20-2.85, P = 0.005; I (2) = 80.70 %, Pheterogeneity < 0.001). Subgroup analysis by statin type showed that the ADRs risk was significantly elevated among simvastatin users (dominant model: pooled effect estimate = 3.43, 95 % CI 1.80-6.52, P = 0.001; I (2) = 59.60 %, Pheterogeneity = 0.060), but not among atorvastatin users. No significant relationship was found between the -388A>G polymorphism and ADRs caused by various statins (dominant model: pooled effect estimate = 0.94, 95 % CI 0.79-1.13, P = 0.526; I (2) = 40.10 %, Pheterogeneity = 0.196). The meta-analysis suggests that SLCO1B1 -521T>C polymorphism may be a risk factor for statin-induced ADRs, especially in simvastatin therapy. Conversely, there may be no significant association for -388A>G polymorphism.
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Affiliation(s)
- Jiajia Jiang
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Qing Tang
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Jing Feng
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Rong Dai
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Yang Wang
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Yuan Yang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 China
| | - Xiaojun Tang
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Changkai Deng
- Chengdu Women's and Children's Central Hospital, Chengdu, 610000 Sichuan China
| | - Huan Zeng
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Yong Zhao
- School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016 China
| | - Fan Zhang
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, No. 1 Medical College Road, Yuzhong District, Chongqing, 400016 China
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Burt HJ, Riedmaier AE, Harwood MD, Crewe HK, Gill KL, Neuhoff S. Abundance of Hepatic Transporters in Caucasians: A Meta-Analysis. ACTA ACUST UNITED AC 2016; 44:1550-61. [PMID: 27493152 PMCID: PMC5034697 DOI: 10.1124/dmd.116.071183] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/04/2016] [Indexed: 11/22/2022]
Abstract
This study aimed to derive quantitative abundance values for key hepatic transporters suitable for in vitro–in vivo extrapolation within a physiologically based pharmacokinetic modeling framework. A meta-analysis was performed whereby data on abundance measurements, sample preparation methods, and donor demography were collated from the literature. To define values for a healthy Caucasian population, a subdatabase was created whereby exclusion criteria were applied to remove samples from non-Caucasian individuals, those with underlying disease, or those with subcellular fractions other than crude membrane. Where a clinically relevant active genotype was known, only samples from individuals with an extensive transporter phenotype were included. Authors were contacted directly when additional information was required. After removing duplicated samples, the weighted mean, geometric mean, standard deviation, coefficient of variation, and between-study homogeneity of transporter abundances were determined. From the complete database containing 24 transporters, suitable abundance data were available for 11 hepatic transporters from nine studies after exclusion criteria were applied. Organic anion transporting polypeptides OATP1B1 and OATP1B3 showed the highest population abundance in healthy adult Caucasians. For several transporters, the variability in abundance was reduced significantly once the exclusion criteria were applied. The highest variability was observed for OATP1B3 > OATP1B1 > multidrug resistance protein 2 > multidrug resistance gene 1. No relationship was found between transporter expression and donor age. To our knowledge, this study provides the first in-depth analysis of current quantitative abundance data for a wide range of hepatic transporters, with the aim of using these data for in vitro–in vivo extrapolation, and highlights the significance of investigating the background of tissue(s) used in quantitative transporter proteomic studies. Similar studies are now warranted for other ethnicities.
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Affiliation(s)
- Howard J Burt
- Simcyp Limited (a Certara Company), Sheffield, United Kingdom
| | | | | | - H Kim Crewe
- Simcyp Limited (a Certara Company), Sheffield, United Kingdom
| | | | - Sibylle Neuhoff
- Simcyp Limited (a Certara Company), Sheffield, United Kingdom
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Neřoldová M, Stránecký V, Hodaňová K, Hartmannová H, Piherová L, Přistoupilová A, Mrázová L, Vrablík M, Adámková V, Hubáček JA, Jirsa M, Kmoch S. Rare variants in known and novel candidate genes predisposing to statin-associated myopathy. Pharmacogenomics 2016; 17:1405-14. [PMID: 27296017 DOI: 10.2217/pgs-2016-0071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Genetic variants affecting statin uptake, metabolism or predisposing to muscular diseases may confer susceptibility to statin-induced myopathy. Besides the SLCO1B1 rs4149056 genotype, common genetic variants do not seem to determine statin-associated myopathy. Here we aimed to address the potential role of rare variants. METHODS We performed whole exome sequencing in 88 individuals suffering from statin-associated myopathy and assessed the burden of rare variants using candidate-gene and exome-wide association analysis. RESULTS In the novel candidate gene CLCN1, we identified a heterozygote truncating mutation p.R894* in four patients. In addition, we detected predictably pathogenic case-specific variants in MYOT, CYP3A5, SH3TC2, FBXO32 and RBM20. CONCLUSION These findings support the role of rare variants and nominate loci for follow-up studies.
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Affiliation(s)
- Magdaléna Neřoldová
- Laboratory of Experimental Hepatology, Center for Experimental Medicine, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Viktor Stránecký
- Institute of Inherited Metabolic Diseases, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Kateřina Hodaňová
- Institute of Inherited Metabolic Diseases, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Hana Hartmannová
- Institute of Inherited Metabolic Diseases, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Lenka Piherová
- Institute of Inherited Metabolic Diseases, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Anna Přistoupilová
- Institute of Inherited Metabolic Diseases, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Lenka Mrázová
- Laboratory for Atherosclerosis Research, Center for Experimental Medicine, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Michal Vrablík
- Third Medical Department, First Faculty of Medicine, Charles University & General Faculty Hospital, Prague, Czech Republic
| | - Věra Adámková
- Preventive Cardiology Department, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Jaroslav A Hubáček
- Laboratory for Atherosclerosis Research, Center for Experimental Medicine, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Milan Jirsa
- Laboratory of Experimental Hepatology, Center for Experimental Medicine, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Stanislav Kmoch
- Institute of Inherited Metabolic Diseases, First Medical Faculty, Charles University, Prague, Czech Republic
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Vrablik M, Zlatohlavek L, Stulc T, Adamkova V, Prusikova M, Schwarzova L, Hubacek JA, Ceska R. Statin-associated myopathy: from genetic predisposition to clinical management. Physiol Res 2016; 63:S327-34. [PMID: 25428737 DOI: 10.33549/physiolres.932865] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Statin-associated myopathy (SAM) represents a broad spectrum of disorders from insignificant myalgia to fatal rhabdomyolysis. Its frequency ranges from 1-5 % in clinical trials to 15-20 % in everyday clinical practice. To a large extent, these variations can be explained by the definition used. Thus, we propose a scoring system to classify statin-induced myopathy according to clinical and biochemical criteria as 1) possible, 2) probable or 3) definite. The etiology of this disorder remains poorly understood. Most probably, an underlying genetic cause is necessary for overt SAM to develop. Variants in a few gene groups that encode proteins involved in: i) statin metabolism and distribution (e.g. membrane transporters and enzymes; OATP1B1, ABCA1, MRP, CYP3A4), ii) coenzyme Q10 production (e.g. COQ10A and B), iii) energy metabolism of muscle tissue (e.g. PYGM, GAA, CPT2) and several others have been proposed as candidates which can predispose to SAM. Pharmacological properties of individual statin molecules (e.g. lipophilicity, excretion pathways) and patients´ characteristics influence the likelihood of SAM development. This review summarizes current data as well as our own results.
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Affiliation(s)
- M Vrablik
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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72
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Li JH, Suchindran S, Shah SH, Kraus WE, Ginsburg GS, Voora D. SLCO1B1 genetic variants, long-term low-density lipoprotein cholesterol levels and clinical events in patients following cardiac catheterization. Pharmacogenomics 2016; 16:449-58. [PMID: 25916517 DOI: 10.2217/pgs.15.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM SLCO1B1 variants are associated with intermediate outcomes that may increase risk of death/myocardial infarction (MI) in statin-treated patients. PATIENTS & METHODS In high-risk Caucasians undergoing cardiac catheterization, we tested the association between rs4149056/625T>C and rs2306283/492A>G with low-density lipoprotein cholesterol (LDL-c) over 3 years (n = 1402) and death/MI over 6 years (n = 2994), accounting for statin use or type during follow-up. RESULTS Carriers of the rs4149056 C allele had 6.2 ± 1.7 mg/dl higher LDL-c per C allele (p < 0.001) but were not at higher risk for death/MI (p = 0.9). We found no associations between rs2306283 and LDL-c or death/MI (p > 0.6). CONCLUSION Functional SLCO1B1 variants are not associated with death/MI in patients commonly treated with statins, despite higher LDL-c in carriers of the rs4149056 C allele.
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Affiliation(s)
- Josephine H Li
- Duke Center for Applied Genomics & Precision Medicine, Duke University, 101 Science Drive, Durham, NC 27705, USA
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Abstract
Statins have become an important drug in preventing the occurrence of atherosclerotic cardiovascular disease (ASCVD). The effectiveness of statins in reducing ASCVD has been established in large-scale clinical trials. The lipid management guidelines have been periodically modified due to accumulating evidence about the proportionate benefit achieved with a progressive reduction in cholesterol levels with higher doses of statins and even in those at low risk of development of ASCVD. The current American College of Cardiology/American Heart Association guidelines have based its recommendations from data gathered exclusively from randomized controlled trials. It has simplified the use of statins, but also raised questions regarding the validity of its cardiovascular event risk prediction tool. Epidemiology of cardiovascular disease in India differs from the western population; there is an increased the prevalence of metabolic syndrome and atherogenic dyslipidemia phenotype a group not addressed in the current guidelines. The guidelines are based on trials, which do not have a representative South Asian population. This article reviews the relevant literature, and examines the issues involved in adopting the guidelines to the Indian population.
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Affiliation(s)
- Anil S. Menon
- Department of Endocrinology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Narendra Kotwal
- Department of Endocrinology, Army Hospital (R and R), New Delhi, India
| | - Yashpal Singh
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| | - R. Girish
- Department of Cardiology, Command Hospital, Lucknow, Uttar Pradesh, India
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Hou Q, Li S, Li L, Li Y, Sun X, Tian H. Association Between SLCO1B1 Gene T521C Polymorphism and Statin-Related Myopathy Risk: A Meta-Analysis of Case-Control Studies. Medicine (Baltimore) 2015; 94:e1268. [PMID: 26376374 PMCID: PMC4635788 DOI: 10.1097/md.0000000000001268] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/22/2015] [Accepted: 07/09/2015] [Indexed: 02/05/2023] Open
Abstract
Statin-related myopathy is an important adverse effect of statin which is classically unpredictable. The evidence of association between solute carrier organic anion transporter 1B1 (SLCO1B1) gene T521C polymorphism and statin-related myopathy risk remained controversial. This study aimed to investigate this genetic association. Databases of PubMed, EMBASE, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database, and Wanfang Data were searched till June 17, 2015. Case-control studies investigating the association between SLCO1B1 gene T521C polymorphism and statin-related myopathy risk were included. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of included studies. Data were pooled by odds ratios (ORs) and their 95% confidence intervals (CIs). Nine studies with 1360 cases and 3082 controls were included. Cases of statin-related myopathy were found to be significantly associated with the variant C allele (TC + CC vs TT: OR = 2.09, 95% CI = 1.27-3.43, P = 0.003; C vs T: OR = 2.10, 95% CI = 1.43-3.09, P < 0.001), especially when statin-related myopathy was defined as an elevation of creatine kinase (CK) >10 times the upper limit of normal (ULN) or rhabdomyolysis (TC + CC vs TT: OR = 3.83, 95% CI = 1.41-10.39, P = 0.008; C vs T: OR = 2.94, 95% CI = 1.47-5.89, P = 0.002). When stratified by statin type, the association was significant in individuals receiving simvastatin (TC + CC vs TT: OR = 3.09, 95% CI = 1.64-5.85, P = 0.001; C vs T: OR = 3.00, 95% CI = 1.38-6.49, P = 0.005), but not in those receiving atorvastatin (TC + CC vs TT: OR = 1.31, 95% CI = 0.74-2.30, P = 0.35; C vs T: OR = 1.33, 95% CI = 0.57-3.12, P = 0.52). The available evidence suggests that SLCO1B1 gene T521C polymorphism is associated with an increased risk of statin-related myopathy, especially in individuals receiving simvastatin. Thus, a genetic test before initiation of statins may be meaningful for personalizing the treatment.
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Affiliation(s)
- Qingtao Hou
- From the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China (QH, SL, HT); Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China (LL, XS); and Department of Endocrinology and Metabolism, The Third People's Hospital of Chengdu, Chengdu, China (YL)
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Mirošević Skvrce N, Macolić Šarinić V, Šimić I, Ganoci L, Muačević Katanec D, Božina N. ABCG2 gene polymorphisms as risk factors for atorvastatin adverse reactions: a case-control study. Pharmacogenomics 2015; 16:803-15. [PMID: 26086347 DOI: 10.2217/pgs.15.47] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM To explore the association between dose-related adverse drug reactions (ADRs) of atorvastatin and polymorphisms of ABCG2, taking into account the influence of CYP3A4 and SLCO1B1 genes. MATERIALS & METHODS Sixty patients who experienced atorvastatin dose-related ADRs and 90 matched patients without ADRs were enrolled in the study. Genotyping for ABCG2 421C > A, CYP3A4*22, SLCO1B1 388A > G, SLCO1B1 521T > C variants was performed by real-time PCR. RESULTS Patients with ABCG2 421CA or AA genotypes had 2.9 times greater odds of developing atorvastatin dose-dependent ADRs (OR: 2.91; 95% CI: 1.22-6.95; p = 0.016) than those with ABCG2 421CC genotype. After adjustments for clinical and genetic risk factors, ABCG2 remained a statistically significant predictor of adverse drug reactions (OR: 2.75; 95% CI: 1.1-6.87; p = 0.03;). Also, carriers of SLCO1B1 521 TC or CC genotypes had 2.3 greater odds (OR: 1.03-4.98; 95% CI: 1.03-4.98; p = 0.043) of experiencing ADRs caused by atorvastatin in comparison with carriers of SLCO1B1 521 TT genotype. CONCLUSION Our study demonstrated an association between atorvastatin-induced ADRs and genetic variants in the ABCG2 gene.
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Affiliation(s)
| | | | - Iveta Šimić
- Department of Internal Medicine, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Lana Ganoci
- Department of Laboratory Diagnostics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Diana Muačević Katanec
- Department of Internal Medicine, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Nada Božina
- Department of Laboratory Diagnostics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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Hubáček JA, Dlouhá D, Adámková V, Zlatohlavek L, Viklický O, Hrubá P, Češka R, Vrablík M. SLCO1B1 polymorphism is not associated with risk of statin-induced myalgia/myopathy in a Czech population. Med Sci Monit 2015; 21:1454-9. [PMID: 25992810 PMCID: PMC4450600 DOI: 10.12659/msm.893007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Gene SLCO1B1, encoding solute organic anionic transport polypeptide OATP1B1, belongs to the group of candidates potentially influencing statin treatment safety. OATP1B1 regulates (not only) the hepatic uptake of statins. Its genetic variation was described as an important predictor of statin-associated myopathy in a cohort of patients treated with a maximum dose of simvastatin. However, the impact of SLCO1B1 gene polymorphism on this risk in patients treated with other statins or lower doses of simvastatin needs to be assessed. Therefore, we performed the present study. Material/Methods SLCO1B1 tagging rs4363657 polymorphism was analyzed in 2 groups of patients with dyslipidemia (treated with simvastatin or atorvastatin, 10 or 20 mg per day), subgroup with statin-induced myalgia (N=286), and subgroup (N=707) without myalgia/myopathy, and in 2301 population controls without lipid-lowering treatment. Results Frequency of the individual genotypes in patients with myalgia/myopathy (TT=62.3%, CT=34.5%, CC=2.8%) did not significantly differ (both P values over 0.19) from that in patients without muscle symptoms (TT=61.4%, CT=32.9%, CC=5.7%) or from the population controls (TT=63.9%, CT=32.5%, CC=3.6%). Null results were also obtained for the dominant and recessive models of the analysis. Conclusions In Czech patients treated with low statin doses, there is no association between SLCO1B1 gene polymorphism and risk of myalgia/myopathy.
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Affiliation(s)
- Jaroslav A Hubáček
- Department of Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dana Dlouhá
- Department of Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vera Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lukáš Zlatohlavek
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Ondřej Viklický
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petra Hrubá
- Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Richard Češka
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Michal Vrablík
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University Prague, Prague, Czech Republic
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Dujic T, Zhou K, Donnelly LA, Tavendale R, Palmer CNA, Pearson ER. Association of Organic Cation Transporter 1 With Intolerance to Metformin in Type 2 Diabetes: A GoDARTS Study. Diabetes 2015; 64:1786-93. [PMID: 25510240 PMCID: PMC4452716 DOI: 10.2337/db14-1388] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/24/2014] [Indexed: 12/25/2022]
Abstract
Metformin is the most widely prescribed medication for the treatment of type 2 diabetes (T2D). However, gastrointestinal (GI) side effects develop in ~25% of patients treated with metformin, leading to the discontinuation of therapy in ~5% of cases. We hypothesized that reduced transport of metformin via organic cation transporter 1 (OCT1) could increase metformin concentration in the intestine, leading to increased risk of severe GI side effects and drug discontinuation. We compared the phenotype, carriage of reduced-function OCT1 variants, and concomitant prescribing of drugs known to inhibit OCT1 transport in 251 intolerant and 1,915 fully metformin-tolerant T2D patients. We showed that women and older people were more likely to be intolerant to metformin. Concomitant use of medications, known to inhibit OCT1 activity, was associated with intolerance (odds ratio [OR] 1.63 [95% CI 1.22-2.17], P = 0.001) as was carriage of two reduced-function OCT1 alleles compared with carriage of one or no deficient allele (OR 2.41 [95% CI 1.48-3.93], P < 0.001). Intolerance was over four times more likely to develop (OR 4.13 [95% CI 2.09-8.16], P < 0.001) in individuals with two reduced-function OCT1 alleles who were treated with OCT1 inhibitors. Our results suggest that reduced OCT1 transport is an important determinant of metformin intolerance.
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Affiliation(s)
- Tanja Dujic
- Department of Biochemistry & Clinical Analysis, Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Kaixin Zhou
- Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, Scotland, U.K
| | - Louise A Donnelly
- Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, Scotland, U.K
| | - Roger Tavendale
- Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, Scotland, U.K
| | - Colin N A Palmer
- Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, Scotland, U.K
| | - Ewan R Pearson
- Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, University of Dundee, Dundee, Scotland, U.K.
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Banach M, Rizzo M, Toth PP, Farnier M, Davidson MH, Al-Rasadi K, Aronow WS, Athyros V, Djuric DM, Ezhov MV, Greenfield RS, Hovingh GK, Kostner K, Serban C, Lighezan D, Fras Z, Moriarty PM, Muntner P, Goudev A, Ceska R, Nicholls SJ, Broncel M, Nikolic D, Pella D, Puri R, Rysz J, Wong ND, Bajnok L, Jones SR, Ray KK, Mikhailidis DP. Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Expert Opin Drug Saf 2015; 14:935-55. [PMID: 25907232 DOI: 10.1517/14740338.2015.1039980] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Genetic and immunologic susceptibility to statin-related myopathy. Atherosclerosis 2015; 240:260-71. [PMID: 25818852 DOI: 10.1016/j.atherosclerosis.2015.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 01/14/2023]
Abstract
Statin-related myopathy (SRM) undermines drug adherence that is critical for achieving the benefits of lipid-lowering therapy. While the exact mechanism of SRM remains largely unknown, recent evidence supports specific genetic and immunologic influence on the development of intolerance. Genes of interest include those involved in the pharmacokinetics of statin response (i.e. drug metabolism, uptake transporters, and efflux transporters), pharmacodynamics (i.e. drug toxicity and immune-mediated myopathy), and gene expression. We examine the influence of genetic and immunologic variation on the pharmacokinetics, pharmacodynamics, and gene expression of SRM.
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80
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Banach M, Rizzo M, Toth PP, Farnier M, Davidson MH, Al-Rasadi K, Aronow WS, Athyros V, Djuric DM, Ezhov MV, Greenfield RS, Hovingh GK, Kostner K, Serban C, Lighezan D, Fras Z, Moriarty PM, Muntner P, Goudev A, Ceska R, Nicholls SJ, Broncel M, Nikolic D, Pella D, Puri R, Rysz J, Wong ND, Bajnok L, Jones SR, Ray KK, Mikhailidis DP. Statin intolerance - an attempt at a unified definition. Position paper from an International Lipid Expert Panel. Arch Med Sci 2015; 11:1-23. [PMID: 25861286 PMCID: PMC4379380 DOI: 10.5114/aoms.2015.49807] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/08/2015] [Accepted: 03/10/2015] [Indexed: 02/07/2023] Open
Abstract
Statins are one of the most commonly prescribed drugs in clinical practice. They are usually well tolerated and effectively prevent cardiovascular events. Most adverse effects associated with statin therapy are muscle-related. The recent statement of the European Atherosclerosis Society (EAS) has focused on statin associated muscle symptoms (SAMS), and avoided the use of the term 'statin intolerance'. Although muscle syndromes are the most common adverse effects observed after statin therapy, excluding other side effects might underestimate the number of patients with statin intolerance, which might be observed in 10-15% of patients. In clinical practice, statin intolerance limits effective treatment of patients at risk of, or with, cardiovascular disease. Knowledge of the most common adverse effects of statin therapy that might cause statin intolerance and the clear definition of this phenomenon is crucial to effectively treat patients with lipid disorders. Therefore, the aim of this position paper was to suggest a unified definition of statin intolerance, and to complement the recent EAS statement on SAMS, where the pathophysiology, diagnosis and the management were comprehensively presented.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Peter P. Toth
- University of Illinois College of Medicine, Peoria, IL, USA
| | | | | | | | - Wilbert S. Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Vasilis Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dragan M. Djuric
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marat V. Ezhov
- Department of Atherosclerosis, Cardiology Research Center, Moscow, Russia
| | | | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karam Kostner
- Mater Hospital, University of Queensland, St Lucia, QLD, Australia
| | - Corina Serban
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
| | - Daniel Lighezan
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
| | - Zlatko Fras
- Department of Vascular Medicine, Preventive Cardiology Unit, University Medical Centre Ljubljana, Slovenia Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Patrick M. Moriarty
- Department of Medicine, Schools of Pharmacy and Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Assen Goudev
- Department of Cardiology, Queen Giovanna University Hospital, Sofia, Bulgaria
| | - Richard Ceska
- 3 Department of Internal Medicine, Charles University, Praha, Czech Republic
| | - Stephen J. Nicholls
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, Australia
| | - Marlena Broncel
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Lodz, Poland
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Daniel Pella
- First Department Of Internal Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Košice, Slovakia
| | | | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, Irvine, CA, USA
| | - Laszlo Bajnok
- First Department of Medicine, University of Pecs, Pecs, Hungary
| | - Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Kausik K. Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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81
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Maeda K. Organic Anion Transporting Polypeptide (OATP)1B1 and OATP1B3 as Important Regulators of the Pharmacokinetics of Substrate Drugs. Biol Pharm Bull 2015; 38:155-68. [DOI: 10.1248/bpb.b14-00767] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kazuya Maeda
- Laboratory of Molecular Pharmacokinetics, Graduate School of Pharmaceutical Sciences,
The University of Tokyo
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82
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Abstract
PURPOSE OF REVIEW To examine the current evidence concerning the effects of genetic variation on statin-related low-density lipoprotein cholesterol reductions, clinical efficacy, and adverse events and the relevance for patient care. RECENT FINDINGS Recent years have seen the emergence of large-scale genetic experiments, including genome-wide association studies and candidate gene studies, exploring the impact of common genetic variation on patient response to statins. These studies have built on previous smaller scale evidence, providing improved statistical power and enhanced ability to explore the genome. Current evidence suggests that common genetic variants do not alter low-density lipoprotein cholesterol response by more than a few percent, or materially alter the effect of statin on vascular risk reduction, and therefore that patients benefit from statins independent of common genetic variation. However, knowledge of SLCO1B1 genotypes is believed to have clinical utility for predicting myopathy risk and ensuring that statins are prescribed as safely as possible. Furthermore, new hypothesis-generating studies, such as those associating GATM with myopathy risk, offer potential insights for the future. SUMMARY Common genetic variation does not appear to be an important determinant of statin response, with the exception of SLCO1B1 and risk of myopathy. Future studies will help to determine the impact of low-frequency and rare genetic variation on statin response.
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Affiliation(s)
- Jemma C Hopewell
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK *Jemma C. Hopewell, Christina Reith and Jane Armitage contributed equally to the writing of this article
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83
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Mahadevan L, Yesudas A, Sajesh PK, Revu S, Kumar P, Santhosh D, Santhosh S, Sashikumar JM, Gopalakrishnan VK, Boben J, Rajesh C. Prevalence of genetic variants associated with cardiovascular disease risk and drug response in the Southern Indian population of Kerala. INDIAN JOURNAL OF HUMAN GENETICS 2014; 20:175-84. [PMID: 25400347 PMCID: PMC4228570 DOI: 10.4103/0971-6866.142896] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM: This study reports the prevalence of five clinically significant variants associated with increased risk of cardiovascular disorders, and variable responses of individuals to commonly prescribed cardiovascular drugs in a South Indian population from the state of Kerala. MATERIALS AND METHODS: Genomic DNA isolated from 100 out-patient samples from Kerala were sequenced to examine the frequency of clinically relevant polymorphisms in the genes MYBPC3 (cardiomyopathy), SLCO1B1 (statin-induced myopathy), CYP2C9, VKORC1 (response to warfarin) and CYP2C19 (response to clopidogrel). RESULTS: Our analyses revealed the frequency of a 25 bp deletion variant of MYBPC3 associated with risk of cardiomyopathy was 7%, and the SLCO1B1 “C” allele associated with risk for statin-induced myopathy was 15% in this sample group. Among the other variants associated with dose-induced toxicity of warfarin, VKORC1 (c.1639G>A), was detected at 22%, while CYP2C9*3 and CYP2C9*2 alleles were present at a frequency of 15% and 3% respectively. Significantly, the tested sample population showed high prevalence (66%) of CYP2C19*2 variant, which determines response to clopidogrel therapy. CONCLUSIONS: We have identified that certain variants associated with cardiovascular disease and related drug response in the five genes, especially those in VKORC1, CYP2C19 and MYBPC3, are highly prevalent in the Kerala population, with almost 2 times higher prevalence of CYP2C19*2 variant compared with other regions in the country. Since the variants chosen in this study have relevance in disease phenotype and/or drug response, and are detected at a higher frequency, this study is likely to encourage clinicians to perform genetic testing before prescribing therapy.
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Affiliation(s)
- Lakshmi Mahadevan
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - Ancy Yesudas
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - P K Sajesh
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - S Revu
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - Prasanna Kumar
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - Devi Santhosh
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - Sam Santhosh
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
| | - J M Sashikumar
- Department of Biotechnology, Karpagam University, Coimbatore, Tamil Nadu, India
| | - V K Gopalakrishnan
- Department of Biochemistry, Karpagam University, Coimbatore, Tamil Nadu, India
| | - Joji Boben
- Meditrina Cardiac Centre, St. Thomas Hospital, Changanassery, Kerala, India
| | - Changanamkandath Rajesh
- MedGenome (Division of Molecular Diagnostics), SciGenom Labs Pvt. Ltd, CSEZ, Kakkanad, Cochin, Kerala, India
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84
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Kell DB, Oliver SG. How drugs get into cells: tested and testable predictions to help discriminate between transporter-mediated uptake and lipoidal bilayer diffusion. Front Pharmacol 2014; 5:231. [PMID: 25400580 PMCID: PMC4215795 DOI: 10.3389/fphar.2014.00231] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022] Open
Abstract
One approach to experimental science involves creating hypotheses, then testing them by varying one or more independent variables, and assessing the effects of this variation on the processes of interest. We use this strategy to compare the intellectual status and available evidence for two models or views of mechanisms of transmembrane drug transport into intact biological cells. One (BDII) asserts that lipoidal phospholipid Bilayer Diffusion Is Important, while a second (PBIN) proposes that in normal intact cells Phospholipid Bilayer diffusion Is Negligible (i.e., may be neglected quantitatively), because evolution selected against it, and with transmembrane drug transport being effected by genetically encoded proteinaceous carriers or pores, whose “natural” biological roles, and substrates are based in intermediary metabolism. Despite a recent review elsewhere, we can find no evidence able to support BDII as we can find no experiments in intact cells in which phospholipid bilayer diffusion was either varied independently or measured directly (although there are many papers where it was inferred by seeing a covariation of other dependent variables). By contrast, we find an abundance of evidence showing cases in which changes in the activities of named and genetically identified transporters led to measurable changes in the rate or extent of drug uptake. PBIN also has considerable predictive power, and accounts readily for the large differences in drug uptake between tissues, cells and species, in accounting for the metabolite-likeness of marketed drugs, in pharmacogenomics, and in providing a straightforward explanation for the late-stage appearance of toxicity and of lack of efficacy during drug discovery programmes despite macroscopically adequate pharmacokinetics. Consequently, the view that Phospholipid Bilayer diffusion Is Negligible (PBIN) provides a starting hypothesis for assessing cellular drug uptake that is much better supported by the available evidence, and is both more productive and more predictive.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry, The University of Manchester Manchester, UK ; Manchester Institute of Biotechnology, The University of Manchester Manchester, UK
| | - Stephen G Oliver
- Department of Biochemistry, University of Cambridge Cambridge, UK ; Cambridge Systems Biology Centre, University of Cambridge Cambridge, UK
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85
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Postmus I, Trompet S, Deshmukh HA, Barnes MR, Li X, Warren HR, Chasman DI, Zhou K, Arsenault BJ, Donnelly LA, Wiggins KL, Avery CL, Griffin P, Feng Q, Taylor KD, Li G, Evans DS, Smith AV, de Keyser CE, Johnson AD, de Craen AJM, Stott DJ, Buckley BM, Ford I, Westendorp RGJ, Eline Slagboom P, Sattar N, Munroe PB, Sever P, Poulter N, Stanton A, Shields DC, O’Brien E, Shaw-Hawkins S, Ida Chen YD, Nickerson DA, Smith JD, Pierre Dubé M, Matthijs Boekholdt S, Kees Hovingh G, Kastelein JJP, McKeigue PM, Betteridge J, Neil A, Durrington PN, Doney A, Carr F, Morris A, McCarthy MI, Groop L, Ahlqvist E, Bis JC, Rice K, Smith NL, Lumley T, Whitsel EA, Stürmer T, Boerwinkle E, Ngwa JS, O’Donnell CJ, Vasan RS, Wei WQ, Wilke RA, Liu CT, Sun F, Guo X, Heckbert SR, Post W, Sotoodehnia N, Arnold AM, Stafford JM, Ding J, Herrington DM, Kritchevsky SB, Eiriksdottir G, Launer LJ, Harris TB, Chu AY, Giulianini F, MacFadyen JG, Barratt BJ, Nyberg F, Stricker BH, Uitterlinden AG, Hofman A, Rivadeneira F, Emilsson V, Franco OH, Ridker PM, Gudnason V, Liu Y, Denny JC, Ballantyne CM, Rotter JI, Adrienne Cupples L, Psaty BM, Palmer CNA, Tardif JC, Colhoun HM, Hitman G, Krauss RM, Wouter Jukema J, Caulfield MJ. Pharmacogenetic meta-analysis of genome-wide association studies of LDL cholesterol response to statins. Nat Commun 2014; 5:5068. [PMID: 25350695 PMCID: PMC4220464 DOI: 10.1038/ncomms6068] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/22/2014] [Indexed: 11/17/2022] Open
Abstract
Statins effectively lower LDL cholesterol levels in large studies and the observed interindividual response variability may be partially explained by genetic variation. Here we perform a pharmacogenetic meta-analysis of genome-wide association studies (GWAS) in studies addressing the LDL cholesterol response to statins, including up to 18,596 statin-treated subjects. We validate the most promising signals in a further 22,318 statin recipients and identify two loci, SORT1/CELSR2/PSRC1 and SLCO1B1, not previously identified in GWAS. Moreover, we confirm the previously described associations with APOE and LPA. Our findings advance the understanding of the pharmacogenetic architecture of statin response.
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Affiliation(s)
- Iris Postmus
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
- The Netherlands Consortium for Healthy Ageing, Leiden 2300 RC, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - Harshal A. Deshmukh
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Michael R. Barnes
- Genome Centre, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London EC1M6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK
| | - Xiaohui Li
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Helen R. Warren
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London EC1M6BQ, UK
| | - Daniel I. Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215-1204, USA
- Harvard Medical School, Boston, Massachusetts 02215, USA
| | - Kaixin Zhou
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Benoit J. Arsenault
- Montreal Heart Institute, Universite de Montreal, Montreal H1T 1C8, Quebec, Canada
| | - Louise A. Donnelly
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Kerri L. Wiggins
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 98101 Seattle, Washington, USA
| | - Christy L. Avery
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Paula Griffin
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02215, USA
| | - QiPing Feng
- Department of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee 37240, USA
| | - Kent D. Taylor
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Guo Li
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 98101 Seattle, Washington, USA
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute, San Francisco, California 94107, USA
| | - Albert V. Smith
- Icelandic Heart Association, IS-201 Kopavogur, Iceland
- University of Iceland, IS-101 Reykjavik, Iceland
| | - Catherine E. de Keyser
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
- Health Care Inspectorate, 2595 AN The Hague, The Netherlands
| | - Andrew D. Johnson
- Framingham Heart Study (FHS) of the National Heart, Lung and Blood Institute, Cardiovascular Epidemiology and Human Genomics, Framingham, Massachusetts 01702, USA
| | - Anton J. M. de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
- The Netherlands Consortium for Healthy Ageing, Leiden 2300 RC, The Netherlands
| | - David J. Stott
- Faculty of Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, UK
| | - Brendan M. Buckley
- Department of Pharmacology and Therapeutics, University College Cork, Cork 30, Ireland
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK
| | - Rudi G. J. Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
- The Netherlands Consortium for Healthy Ageing, Leiden 2300 RC, The Netherlands
- Leyden Academy of Vitality and Ageing, 2333 AA Leiden, The Netherlands
| | - P. Eline Slagboom
- The Netherlands Consortium for Healthy Ageing, Leiden 2300 RC, The Netherlands
- Department of Molecular Epidemiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Naveed Sattar
- Faculty of Medicine, BHF Glasgow Cardiovascular Research Centre, Glasgow G12 8QQ, UK
| | - Patricia B. Munroe
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London EC1M6BQ, UK
| | - Peter Sever
- International Centre for Circulatory Health, Imperial College, London SW7 2AZ, UK
| | - Neil Poulter
- International Centre for Circulatory Health, Imperial College, London SW7 2AZ, UK
| | - Alice Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Beaumont Hospital, Dublin 9, Ireland
| | - Denis C. Shields
- The Conway Institute, University College Dublin, Dublin 4, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin 4, Ireland
| | - Sue Shaw-Hawkins
- Genome Centre, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London EC1M6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK
| | - Y.-D. Ida Chen
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington 98101, USA
| | - Joshua D. Smith
- Department of Genome Sciences, University of Washington, Seattle, Washington 98101, USA
| | - Marie Pierre Dubé
- Montreal Heart Institute, Universite de Montreal, Montreal H1T 1C8, Quebec, Canada
| | - S. Matthijs Boekholdt
- Department of Cardiology, Academic Medical Center, 1100 DD Amsterdam, The Netherlands
| | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, 1100 DD Amsterdam, The Netherlands
| | - John J. P. Kastelein
- Department of Vascular Medicine, Academic Medical Center, 1100 DD Amsterdam, The Netherlands
| | | | | | | | - Paul N. Durrington
- Cardiovascular Research Group, School of Biosciences, University of Manchester, Manchester M13 9NT, UK
| | - Alex Doney
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Fiona Carr
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Andrew Morris
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Mark I. McCarthy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK
- Oxford NIHR Biomedical Research Centre, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK
| | - Leif Groop
- Department of Clinical Sciences/Diabetes & Endocrinology, Lund University, Malmo 205 02, Sweden
| | - Emma Ahlqvist
- Department of Clinical Sciences/Diabetes & Endocrinology, Lund University, Malmo 205 02, Sweden
| | | | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 98101 Seattle, Washington, USA
| | - Kenneth Rice
- Department of Biostatistics, University of Washington, 98115 Seattle, Washington, USA
| | - Nicholas L. Smith
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington 98101, USA
| | - Thomas Lumley
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 98101 Seattle, Washington, USA
- Department of Statistic, University of Auckland, Auckland 1142, New Zealand
| | - Eric A. Whitsel
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Julius S. Ngwa
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02215, USA
| | - Christopher J. O’Donnell
- NHLBI Framingham Heart Study, Framingham, Massachusetts 01701, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA
| | - Ramachandran S. Vasan
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, and the Framingham Heart Study, Framingham, Massachusetts 01701, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee 37240, USA
| | - Russell A. Wilke
- Department of Internal Medicine, Center for IMAGENETICS, Sanford Healthcare, Fargo, North Dakota, 58104 USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02215, USA
| | - Fangui Sun
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02215, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington 98101, USA
| | - Wendy Post
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 98101 Seattle, Washington, USA
- Division of Cardiology, Harborview Medical Center, University of Washington, Seattle 98101, Washington, USA
| | - Alice M. Arnold
- Department of Biostatistics, University of Washington, 98115 Seattle, Washington, USA
| | - Jeanette M. Stafford
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Jingzhong Ding
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - David M. Herrington
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Stephen B. Kritchevsky
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | | | - Leonore J. Launer
- Laboratory of Epidemiology, Demography, Biometry, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Avenue, Bethesda, Maryland 20892, USA
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography, Biometry, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Avenue, Bethesda, Maryland 20892, USA
| | - Audrey Y. Chu
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215-1204, USA
| | - Franco Giulianini
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215-1204, USA
| | - Jean G. MacFadyen
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215-1204, USA
| | - Bryan J. Barratt
- Personalised Healthcare and Biomarkers, AstraZeneca, Alderley Park SK10 4TG, UK
| | - Fredrik Nyberg
- AstraZeneca Research and Development, 481 83 Mölndal, Sweden
- Unit of Occupational and Environmental Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
- Health Care Inspectorate, 2595 AN The Hague, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - André G. Uitterlinden
- The Netherlands Consortium for Healthy Ageing, Leiden 2300 RC, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Albert Hofman
- The Netherlands Consortium for Healthy Ageing, Leiden 2300 RC, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | | | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Paul M. Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02215-1204, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, IS-201 Kopavogur, Iceland
- University of Iceland, IS-101 Reykjavik, Iceland
| | - Yongmei Liu
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee 37240, USA
- Department of Medicine, Vanderbilt University, Vanderbilt, Tennessee 37240, USA
| | | | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts 02215, USA
- NHLBI Framingham Heart Study, Framingham, Massachusetts 01701, USA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 98101 Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington 98195, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington 98101, USA
- Department of Health Services, University of Washington, Seattle, Washington 98101, USA
| | - Colin N. A. Palmer
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Jean-Claude Tardif
- Montreal Heart Institute, Universite de Montreal, Montreal H1T 1C8, Quebec, Canada
| | - Helen M. Colhoun
- Medical Research Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
- Department of Public Health, University of Dundee, Dundee DD1 9SY, UK
| | - Graham Hitman
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Ronald M. Krauss
- Children’s Hospital Oakland Research Institute, Oakland, California 94609, USA
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
- Durrer Center for Cardiogenetic Research, 1105 AZ Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, 3511 GC Utrecht, The Netherlands
| | - Mark J. Caulfield
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London EC1M6BQ, UK
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86
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Alfirevic A, Neely D, Armitage J, Chinoy H, Cooper RG, Laaksonen R, Carr DF, Bloch KM, Fahy J, Hanson A, Yue QY, Wadelius M, Maitland-van Der Zee AH, Voora D, Psaty BM, Palmer CNA, Pirmohamed M. Phenotype standardization for statin-induced myotoxicity. Clin Pharmacol Ther 2014; 96:470-6. [PMID: 24897241 PMCID: PMC4172546 DOI: 10.1038/clpt.2014.121] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/27/2014] [Indexed: 11/12/2022]
Abstract
Statins are widely used lipid-lowering drugs that are effective in reducing cardiovascular disease risk. Although they are generally well tolerated, they can cause muscle toxicity, which can lead to severe rhabdomyolysis. Research in this area has been hampered to some extent by the lack of standardized nomenclature and phenotypic definitions. We have used numerical and descriptive classifications and developed an algorithm to define statin-related myotoxicity phenotypes, including myalgia, myopathy, rhabdomyolysis, and necrotizing autoimmune myopathy.
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Affiliation(s)
- A Alfirevic
- Department of Molecular and Clinical Pharmacology, TheWolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - D Neely
- Department of Clinical Biochemistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - H Chinoy
- Centre for Musculoskeletal Research/NIHR Manchester Musculoskeletal Biomedical Research Unit, University of Manchester, Manchester, UK
| | - R G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - R Laaksonen
- Zora Biosciences Ltd, Tieotie 2, Espoo, Finland
| | - D F Carr
- Department of Molecular and Clinical Pharmacology, TheWolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K M Bloch
- Department of Molecular and Clinical Pharmacology, TheWolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J Fahy
- Department of Molecular and Clinical Pharmacology, TheWolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A Hanson
- Department of Molecular and Clinical Pharmacology, TheWolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Q-Y Yue
- The Medical Products Agency, Uppsala, Sweden
| | - M Wadelius
- Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - A H Maitland-van Der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - D Voora
- Duke Institute for Genome Sciences and Policy, Durham, North Carolina, USA
| | - B M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - C N A Palmer
- Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - M Pirmohamed
- Department of Molecular and Clinical Pharmacology, TheWolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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87
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Abstract
Statins are widely used and have been proven to be effective in the prevention of atherosclerotic vascular disease events, primarily by reducing plasma low-density lipoprotein cholesterol concentrations. Although statins are generally well tolerated and present an excellent safety profile, adverse effects from muscle toxicity and liver enzyme abnormalities may occur in some patients. Myopathy and rhabdomyolysis are rare with statin monotherapy at the approved dose ranges, but the risk increases with use of higher doses, interacting drugs and genetic predisposition. Asymptomatic increases in liver transaminases with statin treatment do not seem to be associated with an increased risk of liver disease. Therefore, statin treatment can be safely used in patients with mild to moderately abnormal liver tests that are potentially attributable to nonalcoholic fatty liver disease and can improve liver tests and reduce cardiovascular morbidity in this group of patients. The risks of other unfavorable effects such as the slightly increased risk of new-onset diabetes and potentially increased risk of haemorrhagic stroke are much smaller than the cardiovascular benefits with the use of statins.
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Affiliation(s)
- Miao Hu
- Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Bernard M Y Cheung
- Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Brian Tomlinson
- Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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88
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Abstract
Statins form the pharmacologic cornerstone of the primary and secondary prevention of atherosclerotic cardiovascular disease. In addition to beneficial cardiovascular effects, statins seem to have multiple non-cardiovascular effects. Although early concerns about statin induced hepatotoxicity and cancer have subsided owing to reassuring evidence, two of the most common concerns that clinicians have are myopathy and diabetes. Randomized controlled trials suggest that statins are associated with a modest increase in the risk of myositis but not the risk of myalgia. Severe myopathy (rhabdomyolysis) is rare and often linked to a statin regimen that is no longer recommended (simvastatin 80 mg). Randomized controlled trials and meta-analyses suggest an increase in the risk of diabetes with statins, particularly with higher intensity regimens in people with two or more components of the metabolic syndrome. Other non-cardiovascular effects covered in this review are contrast induced nephropathy, cognition, cataracts, erectile dysfunction, and venous thromboembolism. Currently, systematic reviews and clinical practice guidelines indicate that the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk. Literature is also accumulating on the potential non-cardiovascular benefits of statins, which could lead to novel applications of this class of drug in the future.
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Affiliation(s)
- Chintan S Desai
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
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89
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Gryn SE, Kim RB. Personalized medicine: importance of clinical interpretative skills for real-world patient care. Per Med 2014; 11:395-408. [PMID: 29783478 DOI: 10.2217/pme.14.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sequencing of the human genome led to great hopes and expectations for a 'genomics revolution' where disease diagnosis as well as therapies would be based on an individual's genetic makeup. Although significant progress has been made, a number of challenging hurdles must be overcome prior to the broader adoption and implementation of pharmacogenomics and personalized medicine as a part of standard patient care. One aspect of pharmacogenomics-based personalized medicine that has not garnered as much attention, a key focus of this perspective, is the importance of interpreting pharmacogenomic test results in a patient-specific clinical context, and expert physicians and other allied health care providers with the requisite expertise in clinical pharmacology and genomics who are able to provide such services.
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Affiliation(s)
- Steven E Gryn
- Division of Clinical Pharmacology, Department of Medicine, Western University, London Health Sciences Centre-UH; 339 Windermere Road; London, ON. N6A 5A5; Canada
| | - Richard B Kim
- Division of Clinical Pharmacology, Department of Medicine, Western University, London Health Sciences Centre-UH; 339 Windermere Road; London, ON. N6A 5A5; Canada
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90
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Pirmohamed M. Personalized pharmacogenomics: predicting efficacy and adverse drug reactions. Annu Rev Genomics Hum Genet 2014; 15:349-70. [PMID: 24898040 DOI: 10.1146/annurev-genom-090413-025419] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Drug response varies between individuals owing to disease heterogeneity, environmental factors, and genetic factors. Genetic factors can affect both the pharmacokinetics and pharmacodynamics of a drug, leading to changes in local and systemic drug exposure and/or changes in the function of the drug target, altering drug response. Several pharmacogenetic biomarkers are already utilized in clinical practice and have been shown to improve clinical outcomes. However, a large number of other biomarkers have never made it beyond the discovery stage. Concerted effort is needed to improve the translation of pharmacogenetic biomarkers into clinical practice, and this will involve the use of standardized phenotyping and genotyping strategies, collaborative work, multidisciplinary approaches to identifying and replicating associations, and cooperation with industry to facilitate translation and commercialization. Acceptance of these approaches by clinicians, regulators, patients, and the public will be important in determining future success.
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Affiliation(s)
- Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3GL, United Kingdom;
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91
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Wang H, Blumberg JB, Chen CYO, Choi SW, Corcoran MP, Harris SS, Jacques PF, Kristo AS, Lai CQ, Lamon-Fava S, Matthan NR, McKay DL, Meydani M, Parnell LD, Prokopy MP, Scott TM, Lichtenstein AH. Dietary modulators of statin efficacy in cardiovascular disease and cognition. Mol Aspects Med 2014; 38:1-53. [PMID: 24813475 DOI: 10.1016/j.mam.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/14/2014] [Accepted: 04/14/2014] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality in the United States and other developed countries, and is fast growing in developing countries, particularly as life expectancy in all parts of the world increases. Current recommendations for the prevention of cardiovascular disease issued jointly from the American Academy of Cardiology and American Heart Association emphasize that lifestyle modification should be incorporated into any treatment plan, including those on statin drugs. However, there is a dearth of data on the interaction between diet and statins with respect to additive, complementary or antagonistic effects. This review collates the available data on the interaction of statins and dietary patterns, cognition, genetics and individual nutrients, including vitamin D, niacin, omega-3 fatty acids, fiber, phytochemicals (polyphenols and stanols) and alcohol. Of note, although the available data is summarized, the scope is limited, conflicting and disparate. In some cases it is likely there is unrecognized synergism. Virtually no data are available describing the interactions of statins with dietary components or dietary pattern in subgroups of the population, particularly those who may benefit most were positive effects identified. Hence, it is virtually impossible to draw any firm conclusions at this time. Nevertheless, this area is important because were the effects of statins and diet additive or synergistic harnessing the effect could potentially lead to the use of a lower intensity statin or dose.
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Affiliation(s)
- Huifen Wang
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jeffrey B Blumberg
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - C-Y Oliver Chen
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sang-Woon Choi
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Michael P Corcoran
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Susan S Harris
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Paul F Jacques
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Aleksandra S Kristo
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Chao-Qiang Lai
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Stefania Lamon-Fava
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Diane L McKay
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mohsen Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Laurence D Parnell
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Max P Prokopy
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Tammy M Scott
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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92
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Genetic factors affecting statin concentrations and subsequent myopathy: a HuGENet systematic review. Genet Med 2014; 16:810-9. [PMID: 24810685 DOI: 10.1038/gim.2014.41] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/31/2014] [Indexed: 01/14/2023] Open
Abstract
Statins, 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors, have proven efficacy in both lowering low-density-lipoprotein levels and preventing major coronary events, making them one of the most commonly prescribed drugs in the United States. Statins exhibit a class-wide side effect of muscle toxicity and weakness, which has led regulators to impose both dosage limitations and a recall. This review focuses on the best-characterized genetic factors associated with increased statin muscle concentrations, including the genes encoding cytochrome P450 enzymes (CYP2D6, CYP3A4, and CYP3A5), a mitochondrial enzyme (GATM), an influx transporter (SLCO1B1), and efflux transporters (ABCB1 and ABCG2). A systematic literature review was conducted to identify relevant research evaluating the significance of genetic variants predictive of altered statin concentrations and subsequent statin-related myopathy. Studies eligible for inclusion must have incorporated genotype information and must have associated it with some measure of myopathy, either creatine kinase levels or self-reported muscle aches and pains. After an initial review, focus was placed on seven genes that were adequately characterized to provide a substantive review: CYP2D6, CYP3A4, CYP3A5, GATM, SLCO1B1, ABCB1, and ABCG2. All statins were included in this review. Among the genetic factors evaluated, statin-related myopathy appears to be most strongly associated with variants in SLCO1B1.
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93
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Pharmacogenomics, lipid disorders, and treatment options. Clin Pharmacol Ther 2014; 96:36-47. [PMID: 24722394 DOI: 10.1038/clpt.2014.82] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 04/07/2014] [Indexed: 01/14/2023]
Abstract
Statins form the backbone of lipid-lowering therapy in the prevention of cardiovascular disease. Numerous studies have evaluated the effect of genomics on the clinical efficacy and adverse effects of statins. Several gene variants that can be linked to either the pharmacokinetics or pharmacodynamics of statins have been identified as potentially important, although there are some discrepant findings among studies. Effect sizes are modest for lipid-lowering efficacy and perhaps somewhat larger for risk of myopathy, although results are inconsistent. Pharmacogenomics of nonstatin lipid-lowering agents have not been evaluated to the same extent, given their relatively limited use, although there are some promising candidate genes for further study. Finally, with several new classes of lipid-lowering therapies soon becoming available, there may be a potential application for pharmacogenomics to identify patients ideally suited to receive-or those who should avoid-specific medications.
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94
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Li JH, Joy SV, Haga SB, Orlando LA, Kraus WE, Ginsburg GS, Voora D. Genetically guided statin therapy on statin perceptions, adherence, and cholesterol lowering: a pilot implementation study in primary care patients. J Pers Med 2014; 4:147-62. [PMID: 25563221 PMCID: PMC4263970 DOI: 10.3390/jpm4020147] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 11/16/2022] Open
Abstract
Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 genotype guided statin therapy (GGST) are unknown. Primary care patients (n = 58) who were nonadherent to statins and their providers received SLCO1B1*5 genotyping and guided recommendations via the electronic medical record (EMR). The primary outcome was the change in Beliefs about Medications Questionnaire, which measured patients' perceived needs for statins and concerns about adverse effects, measured before and after SLCO1B1*5 results. Concurrent controls (n = 59) were identified through the EMR to compare secondary outcomes: new statin prescriptions, statin utilization, and change in LDL-cholesterol (LDL-c). GGST patients had trends (p = 0.2) towards improved statin necessity and concerns. The largest changes were the "need for statin to prevent sickness" (p < 0.001) and "concern for statin to disrupt life" (p = 0.006). GGST patients had more statin prescriptions (p < 0.001), higher statin use (p < 0.001), and greater decrease in LDL-c (p = 0.059) during follow-up. EMR delivery of SLCO1B1*5 results and recommendations is feasible in the primary care setting. This novel intervention may improve patients' perceptions of statins and physician behaviors that promote higher statin adherence and lower LDL-c.
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Affiliation(s)
- Josephine H Li
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Scott V Joy
- Division of General Internal Medicine, Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Susanne B Haga
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Lori A Orlando
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | - William E Kraus
- Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | - Geoffrey S Ginsburg
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Deepak Voora
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
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95
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Do MDR1 and SLCO1B1 polymorphisms influence the therapeutic response to atorvastatin? A study on a cohort of Egyptian patients with hypercholesterolemia. Mol Diagn Ther 2014; 17:299-309. [PMID: 23677857 DOI: 10.1007/s40291-013-0038-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Statins are among the most prescribed drugs worldwide to reduce the risk of cardiovascular events. Interindividual variability in drug response is a major clinical problem and is of concern during drug development. Statins, such as atorvastatin, are taken orally and access to their site of action in the liver is greatly facilitated by both intestinal and hepatic transporters. OBJECTIVE To examine the impact of polymorphisms of the multidrug resistance 1(MDR1) and solute carrier organic anion transporter 1B1 (SLCO1B1) genes on the therapeutic response to atorvastatin as well as the presence of gender-gene interaction. METHODS Serum lipid levels were determined at baseline and 4 weeks following 40 mg/day atorvastatin treatment in 50 Egyptian hypercholesterolemic patients (27 males and 23 females). Identification of MDR1 C3435T and SLCO1B1 A388G gene polymorphisms was performed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS Treatment with atorvastatin resulted in a mean reduction of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) of 8.7 %, 9.2 %, and 4.1 %, respectively, and a mean increase of high density lipoprotein cholesterol (HDL-C) of 1 %. Baseline and post-treatment HDL-C levels were statistically significantly higher in the MDR 1 TT homozygotes when compared with the CC wild type. The percentage change in TC, LDL-C, TG, and HDL-C did not show any statistically significant difference when compared among the different MDR 1 C3435T or SLCO1B1 A388G genotypes. The SLCO1B1 GG homozygotes showed a decrease in TG, whereas there was an increase in TG following atorvastatin treatment in AA and AG carriers in females; however, males did not show any statistically significant difference. There was no statistically significant association between either the coronary artery disease (CAD) risk factors (family history of CAD, hypertension, diabetes mellitus, smoking) or concomitant medications with the percentage change in different lipid parameters. CONCLUSION MDR1 C3435T was associated with baseline and post-treatment HDL-C variation. SLCO1B1 A388G showed gender-related effects on TG change following atorvastatin treatment. None of the comorbidities or the concomitant medications influenced the percentage change of lipid parameters following atorvastatin treatment. The results of this study may lead to an improved understanding of the genetic determinants of lipid response to atorvastatin treatment.
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96
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Association between statin-induced creatine kinase elevation and genetic polymorphisms in SLCO1B1, ABCB1 and ABCG2. Eur J Clin Pharmacol 2014; 70:539-47. [PMID: 24595600 DOI: 10.1007/s00228-014-1661-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Treatment with statins requires close monitoring of serum creatine kinase (CK) levels to prevent myopathy, a common and potentially serious dose-dependent adverse effect of these drugs. We have investigated the correlation between elevated CK levels and polymorphisms in the genes encoding transporters involved in statin disposition. METHODS Patients with and without statin-induced elevated serum CK levels were genotyped for polymorphisms in SLCO1B1 (SLCO1B1 A388G and SLCO1B1 T521C), ABCB1 (ABCB1 C1236T and ABCB1 C3435T) and ABCG2 (ABCG2 C421A). RESULTS Patients carrying SLCO1B1 T521C or ABCB1 C1236T single nucleotide polymorphisms (SNPs) had an odds ratio (OR) for statin-induced elevated serum CK levels of 8.86 (p<0.01) and 4.67 (p<0.05), respectively, while patients carrying the SLCO1B1 A388G SNP had an OR of 0.24 (p<0.05). An arbitrary score based on genotype combination discriminated patients with and without CK elevation at a specificity of 97 % and a sensitivity of 39 %. CONCLUSION Genotyping of the SLCO1B1, ABCB1 and ABCG2 genes deserves consideration as a clinical approach to improve statin safety while concomitantly reducing the burden of blood tests for CK measurements.
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97
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Talameh JA, Kitzmiller JP. Pharmacogenetics of Statin-Induced Myopathy: A Focused Review of the Clinical Translation of Pharmacokinetic Genetic Variants. ACTA ACUST UNITED AC 2014; 5. [PMID: 25221728 PMCID: PMC4160888 DOI: 10.4172/2153-0645.1000128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Statins are the most commonly prescribed drugs in the United States and are extremely effective in reducing major cardiovascular events in the millions of Americans with hyperlipidemia. However, many patients (up to 25%) cannot tolerate or discontinue statin therapy due to statin-induced myopathy (SIM). Patients will continue to experience SIM at unacceptably high rates or experience unnecessary cardiovascular events (as a result of discontinuing or decreasing their statin therapy) until strategies for predicting or mitigating SIM are identified. A promising strategy for predicting or mitigating SIM is pharmacogenetic testing, particularly of pharmacokinetic genetic variants as SIM is related to statin exposure. Data is emerging on the association between pharmacokinetic genetic variants and SIM. A current, critical evaluation of the literature on pharmacokinetic genetic variants and SIM for potential translation to clinical practice is lacking. This review focuses specifically on pharmacokinetic genetic variants and their association with SIM clinical outcomes. We also discuss future directions, specific to the research on pharmacokinetic genetic variants, which could speed the translation into clinical practice. For simvastatin, we did not find sufficient evidence to support the clinical translation of pharmacokinetic genetic variants other than SLCO1B1. However, SLCO1B1 may also be clinically relevant for pravastatin- and pitavastatin-induced myopathy, but additional studies assessing SIM clinical outcome are needed. CYP2D6*4 may be clinically relevant for atorvastatin-induced myopathy, but mechanistic studies are needed. Future research efforts need to incorporate statin-specific analyses, multi-variant analyses, and a standard definition of SIM. As the use of statins is extremely common and SIM continues to occur in a significant number of patients, future research investments in pharmacokinetic genetic variants have the potential to make a profound impact on public health.
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Affiliation(s)
- Jasmine A Talameh
- Center for Pharmacogenomics, The Ohio State University, Columbus, OH, USA
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Gelissen IC, McLachlan AJ. The pharmacogenomics of statins. Pharmacol Res 2013; 88:99-106. [PMID: 24365577 DOI: 10.1016/j.phrs.2013.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/06/2013] [Accepted: 12/12/2013] [Indexed: 12/24/2022]
Abstract
The statin class of cholesterol-lowering drugs have been used for decades to successfully lower plasma cholesterol concentrations and cardiovascular risk. Adverse effects of statins are generally considered mild, but increase with age of patients and polypharmacy. One aspect of statin therapy that is still difficult for prescribers to predict is the individual's response to statin therapy. Recent advances in the field of pharmacogenomics have indicated variants of candidate genes that affect statin efficacy and safety. In this review, a number of candidates that affect statin pharmacokinetics and pharmacodynamics are discussed. Some of these candidates, in particular those involved in import and efflux of statins, have now been linked to increased risk of side effects. Furthermore, pharmacogenomic studies continue to reveal new players that are involved in the fine-tuning of the complex regulation of cholesterol homeostasis and response to statins.
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Affiliation(s)
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Hospital, Sydney, NSW, Australia
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Abstract
Statin drugs are highly effective in lowering blood concentrations of LDL-cholesterol, with concomitant reduction in risk of major cardiovascular events. Although statins are generally regarded as safe and well-tolerated, some users develop muscle symptoms that are mostly mild but in rare cases can lead to life-threatening rhabdomyolysis. The SEARCH genome-wide association study, which has been independently replicated, found a significant association between the rs4149056 (c.521T>C) single-nucleotide polymorphism (SNP) in the SLCO1B1 gene, and myopathy in individuals taking 80 mg simvastatin per day, with an odds ratio of 4.5 per rs4149056 C allele. The purpose of this paper is to assemble evidence relating to the analytical validity, clinical validity and clinical utility of using SLCO1B1 rs4149056 genotyping to inform choice and dose of statin treatment, with the aim of minimising statin-induced myopathy and increasing adherence to therapy. Genotyping assays for the rs4149056 SNP appear to be robust and accurate, though direct evidence for the performance of array-based platforms in genotyping individual SNPs was not found. Using data from the SEARCH study, calculated values for the clinical sensitivity, specificity, positive- and negative-predictive values of a test for the C allele to predict definite or incipient myopathy during 5 years of 80 mg/day simvastatin use were 70.4%, 73.7%, 4.1% and 99.4% respectively. There is a need for studies comparing the clinical validity of SLCO1B1 rs4149056 genotyping with risk scores for myopathy based on other factors such as racial background, statin type and dose, gender, body mass index, co-medications and co-morbidities. No direct evidence was found for clinical utility of statin prescription guided by SLCO1B1 genotype.
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Affiliation(s)
- Alison Stewart
- McKing Consulting Corp., Atlanta, Georgia, USA; Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Patel J, Abd T, Blumenthal RS, Nasir K, Superko HR. Genetics and Personalized Medicine—a Role in Statin Therapy? Curr Atheroscler Rep 2013; 16:384. [DOI: 10.1007/s11883-013-0384-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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