Cited by 195Pharmacogenetics and Drug MetabolismLipoproteins and Cardiovascular HealthDrug Transport and Resistance Mechanisms

Clinical and pharmacogenetic predictors of circulating atorvastatin and rosuvastatin concentrations in routine clinical care

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DeGorter, Marianne K., Tirona, Rommel G., Schwarz, Ute I., Choi, Yun-Hee, Dresser, George K., Suskin, Neville, Myers, Kathryn, Zou, GuangYong +5 more·2013·Circulation: Cardiovascular Genetics

Abstract

Background—: A barrier to statin therapy is myopathy associated with elevated systemic drug exposure. Our objective was to examine the association between clinical and pharmacogenetic variables and statin concentrations in patients. Methods and Results—: In total, 299 patients taking atorvastatin or rosuvastatin were prospectively recruited at an outpatient referral center. The contribution of clinical variables and transporter gene polymorphisms to statin concentration was assessed using multiple linear regression. We observed 45-fold variation in statin concentration among patients taking the same dose. After adjustment for sex, age, body mass index, ethnicity, dose, and time from last dose, SLCO1B1 c.521T>C ( P <0.001) and ABCG2 c.421C>A ( P <0.01) were important to rosuvastatin concentration (adjusted R 2 =0.56 for the final model). Atorvastatin concentration was associated with SLCO1B1 c.388A>G ( P <0.01) and c.521T>C ( P <0.05) and 4β-hydroxycholesterol, a CYP3A activity marker (adjusted R 2 =0.47). A second cohort of 579 patients from primary and specialty care databases were retrospectively genotyped. In this cohort, genotypes associated with statin concentration were not differently distributed among dosing groups, implying providers had not yet optimized each patient’s risk–benefit ratio. Nearly 50% of patients in routine practice taking the highest doses were predicted to have statin concentrations greater than the 90th percentile. Conclusions—: Interindividual variability in statin exposure in patients is associated with uptake and efflux transporter polymorphisms. An algorithm incorporating genomic and clinical variables to avoid high atorvastatin and rosuvastatin levels is described; further study will determine whether this approach reduces incidence of statin myopathy.

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Crossref · 10.1161/circgenetics.113.000099

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Authors
DeGorter, M. K., Tirona, R. G., Schwarz, U. I., Choi, Y.-H., Dresser, G. K., Suskin, N., Myers, K., Zou, G., Iwuchukwu, O., Wei, W.-Q., Wilke, R. A., Hegele, R. A., & Kim, R. B.
Affiliations
Western University (CA)
Venue
Circulation: Cardiovascular Genetics
Published
2013-08
Volume
6
Issue
4
Pages
400-408
ISSN
  • 1942-325X (ISSN-L)
  • 1942-3268
OpenAlex
W2164884234
Cited by
195
References
50
Citations by year
2026: 5 · 2025: 10 · 2024: 8 · 2023: 17 · 2022: 15 · 2021: 17 · 2020: 23 · 2019: 16 · 2018: 20 · 2017: 11 · 2016: 21 · 2015: 11 · 2014: 16 · 2013: 4
FWCI
18.95
Type
journal article
Language
en
Open access
Locations
  • Circulation Cardiovascular Genetics (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Scholarship@Western (Western University) (submittedVersion)
Funders
  • Canadian Institutes of Health Research (MOP-89753)
  • National Institute of General Medical Sciences (T32GM007569)
  • National Center for Research Resources (UL1RR024975)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Oncology › Drug Transport and Resistance Mechanisms
Keywords
atorvastatin, rosuvastatin, statin-induced myopathy, pharmacogenetics, SLCO1B1, ABCG2, drug transporter polymorphisms, interindividual variability, 4β-hydroxycholesterol, CYP3A activity, statin dosing, statin safety
MeSH terms
Rosuvastatin Calcium, Atorvastatin, ATP Binding Cassette Transporter, Subfamily G, Member 2, Adult, Aged, Aged, 80 and over, Alleles, Cholesterol, Female, Fluorobenzenes, Genotype, Heptanoic Acids, Humans, Hydroxycholesterols, Hypercholesterolemia, Male, Middle Aged, Neoplasm Proteins, Polymorphism, Genetic, Prospective Studies, Pyrimidines, Pyrroles, Retrospective Studies, Sulfonamides, Cohort Studies, Linear Models, Databases, Factual, ATP-Binding Cassette Transporters, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Polymorphism, Single Nucleotide, Organic Anion Transporters, Liver-Specific Organic Anion Transporter 1, Cytochrome P-450 CYP3A

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