Statin therapy: time for a precision medicine approach?

ABSTRACT

Introduction: Statins are beneficial for both primary and secondary prevention of cardiovascular disease in many patients at elevated risk. However, selection of patients most likely to respond and least likely to have adverse effects can benefit from refinement. While pharmacogenomic aspects of statins have been thoroughly evaluated, as yet there has been no major impact on patient care, although there is great potential that a precision medicine approach might one day enhance patient care.

Areas covered: This paper provides a brief overview of genetic variants that influence statin responsiveness, together with newer information on genetic risk scores that combine numerous common DNA variants into a stronger prediction of cardiovascular risk reduction from statins. We also discuss a pharmacokinetic-based approach to aid in prediction and prevention of statin adverse effects.

Expert commentary: While individual genetic variants appear to have statistically significant effects on lipid lowering by statins, such effects are often not clinically significant. However, evaluating simultaneously the cumulative effect of multiple common variants, along with relevant clinical factors, may provide a way forward that allows for better patient selection, and more precisely maximizing benefits while concurrently reducing the risk adverse effects.

KEYWORDS:

• Dyslipidemias
• hypolipidemic agents
• 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors
• pharmacogenetics
• polygenic traits

Declaration of interest

R.A. Hegele is supported by the Jacob J. Wolfe Distinguished Medical Research Chair, the Edith Schulich Vinet Research Chair in Human Genetics and the Martha G. Blackburn Chair in Cardiovascular Research. R.B. Kim is supported by the Wolfe Medical Research Chair in Pharmacogenetics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.