SLCO1B1 Gene-Based Clinical Decision Support Reduces Statin-Associated Muscle Symptoms Risk With Simvastatin

Abstract

Background: SLCO1B1 variants are known to be a strong predictor of statin-associated muscle symptoms (SAMS) risk with simvastatin. Methods: The authors conducted a retrospective chart review on 20,341 patients who had SLCO1B1 genotyping to quantify the uptake of clinical decision support (CDS) for genetic variants known to impact SAMS risk. Results: A total of 182 patients had 417 CDS alerts generated, and 150 of these patients (82.4%) received pharmacotherapy that did not increase risks for SAMS. Providers were more likely to cancel simvastatin orders in response to CDS alerts if genotyping had been done prior to the first simvastatin prescription than after (94.1% vs 28.5%, respectively; p < 0.001). Conclusion: CDS significantly reduces simvastatin prescribing at doses associated with SAMS.

Keywords::

• atherosclerotic cardiovascular disease
• clinical decision support
• genotyping
• simvastatin
• SLCO1B1
• statin-associated muscle symptoms

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pgs-2023-0056

Author contributions

Conceptualization: A Massmann, JV Heukelom, RC Green, C Hajek, MR Hickingbotham, EA Larson, ES Zoltick, KD Christensen, A Schultz; data curation: A Massmann, JV Heukelom, MR Hickingbotham, KD Christensen, A Schultz; formal analysis: MR Hickingbotham, KD Christensen; funding acquisition: RC Green, C Hajek, KD Christensen, A Schultz; investigation: A Massmann, JV Heukelom, MR Hickingbotham, ES Zoltick, KD Christensen, A Schultz; methodology: A Massmann, JV Heukelom, MR Hickingbotham, CY Lu, AC Wu, ES Zoltick, KD Christensen, A Schultz; project administration: C Hajek, MR Hickingbotham, A Schultz; supervision: KD Christensen, A Schultz; validation: A Massmann, JV Heukelom; writing – original draft: A Massmann, JV Heukelom, MR Hickingbotham, ES Zoltick, KD Christensen, A Schultz; writing – review and editing: A Massmann, JV Heukelom, RC Green, C Hajek, MR Hickingbotham, EA Larson, CY Lu, AC Wu, ES Zoltick, KD Christensen, A Schultz.

Acknowledgments

The authors would like to thank Russ Wilke (University of South Dakota Sanford School of Medicine) for helpful comments made during the preparation of this manuscript, Chad Larson for his work assisting with the development of CDS alerts, Mary Kara for her work abstracting data from medical records and the Sanford Medical Genetics Laboratory for analyzing PGx results.

Financial & competing interests disclosure

The Imagenetics Initiative and Sanford Chip Program and this work were supported by Sanford Health. KD Christensen was also supported by grant K01-HG009173 from the NIH. KD Christensen, ES Zoltick and MR Hickingbotham were supported by a research grant from Sanford Health. RC Green has received compensation for advising the following companies – AIA, Embryome, Genome Web, Genomic Life, Grail, Humanity, OptumLabs, Plumcare and Verily – and is co-founder of Genome Medical, Inc. C Hajek is an employee of Helix OpCo, LLC. 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.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The research protocol was approved by the Sanford Health and Harvard Pilgrim Health Care Institute Institutional Review Board. Individual-level patient data were deidentified before provided to the study team, and informed consent was not required.

Data availability statement

Data and analytic code will be made available at request. Inquiries can be directed to the corresponding author.

Additional information

Funding

The Imagenetics Initiative and Sanford Chip Program and this work were supported by Sanford Health. KD Christensen was also supported by grant K01-HG009173 from the NIH. KD Christensen, ES Zoltick and MR Hickingbotham were supported by a research grant from Sanford Health. RC Green has received compensation for advising the following companies – AIA, Embryome, Genome Web, Genomic Life, Grail, Humanity, OptumLabs, Plumcare and Verily – and is co-founder of Genome Medical, Inc. C Hajek is an employee of Helix OpCo, LLC. 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. No writing assistance was utilized in the production of this manuscript.