title: Statin pharmacogenomics: opportunities to improve patient outcomes and healthcare costs with genetic testing.
abstract: HMG-CoA reductase inhibitors, commonly known as statins, are some of the most widely prescribed medications worldwide and have been shown to be effective at lowering cholesterol in numerous long-term prospective trials, yet there are significant limitations to their use. First, patients receiving statin therapy have relatively low levels of medication adherence compared with other drug classes. Next, numerous statin formulations are available, each with its own unique safety and efficacy profile, and it may be unclear to prescribers which treatment is optimal for their patients. Finally, statins have class-wide side effects of myopathy and rhabdomyolysis that have resulted in a product recall and dosage limitations. Recent evidence suggests that two genomic markers, KIF6 and SLCO1B1, may inform the therapy choice of patients initiating statins. Given the prevalence of statin usage, their potential health advantages and their overall cost to the healthcare system, there could be significant clinical benefit from creating personalized treatment regimens. Ultimately, if this approach is effective it may encourage higher adoption of generic statins when appropriate, promote adherence, lower rates of myopathy, and overall achieve higher value cardiovascular care. This paper will review the evidence for personalized prescribing of statins via KIF6 and SLCO1B1 and consider some of the implications for testing these markers as part of routine clinical care.
authors.affiliation: Generation Health, 130 Turner St., Waltham, MA 02453, USA. Canestaro@gmail.com.
authors.forename: William J
authors.initials: WJ
authors.lastname: Canestaro
authors.affiliation: TESARO Inc., 1000 Winter St. Suite 3300, Waltham, MA 02451, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Brooks
authors.affiliation: Generation Health, 130 Turner St., Waltham, MA 02453, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Chaplin
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St., Suite 3030, Boston, MA 02120, USA.
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.affiliation: Generation Health, 130 Turner St., Waltham, MA 02453, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lawler
authors.affiliation: ZIOPHARM Oncology, Inc., 1 First Avenue, Parris Building, #34, Navy Yard Plaza, Boston, MA 02129, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Martell
authors.affiliation: CVS Caremark, One CVS Drive, Woonsocket, RI 02895, USA.
authors.forename: Troyen
authors.initials: T
authors.lastname: Brennan
authors.affiliation: Generation Health, 130 Turner St., Waltham, MA 02453, USA.
authors.forename: E Robert
authors.initials: ER
authors.lastname: Wassman