Genetically Guided Statin Therapy on Statin Perceptions, Adherence, and Cholesterol Lowering: A Pilot Implementation Study in Primary Care Patients

Josephine H. Li¹, Scott V. Joy², Susanne B. Haga¹, Lori A. Orlando³, William E. Kraus⁴, Geoffrey S. Ginsburg^1,4 and Deepak Voora^1,4,*

¹ Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA² Division of General Internal Medicine, Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA³ Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA⁴ Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA

* Author to whom correspondence should be addressed.

Received: 19 December 2013; in revised form: 4 March 2014 / Accepted: 17 March 2014 / Published: 27 March 2014

(This article belongs to the Special Issue Bringing Personalized Medicine into Clinical Practice)

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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 ofSLCO1B1*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.

Keywords: pharmacogenetics; personalized medicine; medication adherence; risk assessment; health behavior; hyperlipidemia