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Pharmacogenomics of statins: lipid response and other outcomes in Brazilian cohorts. Pharmacol Rep 2021; 74:47-66. [PMID: 34403130 DOI: 10.1007/s43440-021-00319-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 01/20/2023]
Abstract
Statins are inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase, a key enzyme in cholesterol biosynthesis, that are highly effective in reducing plasma low-density lipoprotein (LDL) cholesterol and decreasing the risk of cardiovascular events. In recent years, a multitude of variants in genes involved in pharmacokinetics (PK) and pharmacodynamics (PD) have been suggested to influence the cholesterol-lowering response. However, the vast majority of studies have analyzed the pharmacogenetic associations in populations in Europe and the USA, whereas data in other populations, including Brazil, are mostly lacking. This narrative review provides an update of clinical studies on statin pharmacogenomics in Brazilian cohorts exploring lipid-lowering response, adverse events and pleiotropic effects. We find that variants in drug transporter genes (SLCO1B1 and ABCB1) positively impacted atorvastatin and simvastatin response, whereas variants in genes of drug metabolizing enzymes (CYP3A5) decreased response. Furthermore, multiple associations of variants in PD genes (HMGCR, LDLR and APOB) with statin response were identified. Few studies have explored statin-related adverse events, and only ABCB1 but not SLCO1B1 variants were robustly associated with increased risk in Brazil. Statin-related pleiotropic effects were shown to be influenced by variants in PD (LDLR, NR1H2) and antioxidant enzyme (NOS3, SOD2, MTHFR, SELENOP) genes. The findings of these studies indicate that statin pharmacogenomic associations are distinctly different in Brazil compared to other populations. This review also discusses the clinical implications of pharmacogenetic studies and the rising importance of investigating rare variants to explore their association with statin response.
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Hirata RDC, Cerda A, Genvigir FDV, Hirata MH. Pharmacogenetic implications in the management of metabolic diseases in Brazilian populations. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000001005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Wanmasae S, Sirintronsopon W, Porntadavity S, Jeenduang N. The effect ofAPOE,CETP,andPCSK9polymorphisms on simvastatin response in Thai hypercholesterolemic patients. Cardiovasc Ther 2017; 35. [DOI: 10.1111/1755-5922.12302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 07/31/2017] [Accepted: 08/20/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Smith Wanmasae
- School of Allied Health Sciences; Walailak University; Nakhon Si Thammarat Thailand
| | | | - Sureerut Porntadavity
- Department of Clinical Chemistry; Faculty of Medical Technology; Mahidol University; Bangkok Thailand
| | - Nutjaree Jeenduang
- School of Allied Health Sciences; Walailak University; Nakhon Si Thammarat Thailand
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Maxwell WD, Ramsey LB, Johnson SG, Moore KG, Shtutman M, Schoonover JH, Kawaguchi-Suzuki M. Impact of Pharmacogenetics on Efficacy and Safety of Statin Therapy for Dyslipidemia. Pharmacotherapy 2017; 37:1172-1190. [DOI: 10.1002/phar.1981] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Whitney D. Maxwell
- Department of Clinical Pharmacy and Outcomes Sciences; University of South Carolina College of Pharmacy; Columbia South Carolina
| | - Laura B. Ramsey
- Division of Research in Patient Services-Pharmacy Research; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Samuel G. Johnson
- American College of Clinical Pharmacy; Washington District of Columbia
- Virginia Commonwealth University; Richmond Virginia
| | - Kate G. Moore
- Department of Pharmacy Practice; Presbyterian College School of Pharmacy; Clinton South Carolina
| | - Michael Shtutman
- Department of Drug Discovery and Biomedical Sciences; University of South Carolina College of Pharmacy; Columbia South Carolina
| | - John H. Schoonover
- Department of Clinical Pharmacy and Outcomes Sciences; University of South Carolina College of Pharmacy; Columbia South Carolina
| | - Marina Kawaguchi-Suzuki
- School of Pharmacy; Pacific University College of Health Professions; Hillsboro Oregon
- Clinical Pharmacy Services; Kaiser Permanente Northwest; Portland Oregon
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Shin JH, Lee DH. How does the pattern of aeroallergen sensitization change over time across all ages? Int Forum Allergy Rhinol 2017; 7:652-659. [DOI: 10.1002/alr.21942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/03/2017] [Accepted: 03/21/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ji-Hyeon Shin
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine; The Catholic University of Korea; Seoul Republic of Korea
| | - Dong-Hee Lee
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine; The Catholic University of Korea; Seoul Republic of Korea
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Leusink M, Onland-Moret NC, de Bakker PIW, de Boer A, Maitland-van der Zee AH. Seventeen years of statin pharmacogenetics: a systematic review. Pharmacogenomics 2015; 17:163-80. [PMID: 26670324 DOI: 10.2217/pgs.15.158] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM We evaluated the evidence of pharmacogenetic associations with statins in a systematic review. METHODS Two separate outcomes were considered of interest: modification of low-density lipoprotein cholesterol (LDL-C) response and modification of risk for cardiovascular events. RESULTS In candidate gene studies, 141 loci were claimed to be associated with LDL-C response. Only 5% of these associations were positively replicated. In addition, six genome-wide association studies of LDL-C response identified common SNPs in APOE, LPA, SLCO1B1, SORT1 and ABCG2 at genome-wide significance. None of the investigated SNPs consistently affected the risk reduction for cardiovascular events. CONCLUSION Only five genetic loci were consistently associated with LDL-C response. However, as effect sizes are modest, there is no evidence for the value of genetic testing in clinical practice.
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Affiliation(s)
- Maarten Leusink
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul I W de Bakker
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Smiderle L, Fiegenbaum M, Hutz MH, Van Der Sand CR, Van Der Sand LC, Ferreira MEW, Pires RC, Almeida S. ESR1 polymorphisms and statin therapy: a sex-specific approach. THE PHARMACOGENOMICS JOURNAL 2015; 16:507-513. [PMID: 26302681 DOI: 10.1038/tpj.2015.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/28/2015] [Accepted: 07/01/2015] [Indexed: 12/24/2022]
Abstract
Lipid-lowering therapy has shown a high degree of variability in clinical response and there is evidence that the variability in drug response between individuals is due to genetic factors. Thirteen single nucleotide polymorphisms (SNPs) within the ESR1 gene were evaluated with basal lipid and lipoprotein levels, as well as response to lipid-lowering therapy, in 495 hypercholesterolemic individuals of European descent receiving simvastatin or atorvastatin. Significant associations were detected between rs4870061 (P=0.040, corrected P-value (PC)=0.440), rs1801132 (P=0.002, PC=0.022) and the SNP rs3020314 (P=0.013, PC=0.143) with triglyceride (TG) baseline levels. The rs4870061 was also associated with high-density lipoprotein cholesterol (HDL-C) baseline levels (P=0.045, PC=0.495). Regarding statin efficacy, rs2234693 C/C was associated with greater HDL-C increase (P=0.037; PC=0.407) and rs3798577 T allele was associated with greater total cholesterol (TC) reduction (P=0.019; PC=0.209) and greater TG reduction (P=0.026; PC=0.286). These associations suggest that ESR1 polymorphisms are in part responsible for the TC, HDL-C and TG variation levels and this effect may be sex-specific.
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Affiliation(s)
- L Smiderle
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - M Fiegenbaum
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil.,Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - M H Hutz
- Departamento de Genética, Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, Brazil
| | | | | | - M E W Ferreira
- Centro de Diagnóstico Cardiológico, Porto Alegre, Brazil
| | - R C Pires
- Centro de Diagnóstico Cardiológico, Porto Alegre, Brazil
| | - S Almeida
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil.,Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
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de Souza JA, Menin A, Lima LO, Smiderle L, Hutz MH, Van Der Sand CR, Van Der Sand LC, Ferreira MEW, Pires RC, Almeida S, Fiegenbaum M. PON1 polymorphisms are predictors of ability to attain HDL-C goals in statin-treated patients. Clin Biochem 2015; 48:1039-44. [PMID: 26079344 DOI: 10.1016/j.clinbiochem.2015.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES PON1 plays an important role in inhibiting LDL-C oxidation, which reduces atherosclerosis and cardiovascular disease. Elevated PON1 activity or levels may contribute to increased HDL-C levels, but controversy exists over the hypothesis that genetic variation in the PON1 gene locus modulates HDL-C levels and responses to statin treatment. Therefore, the objective of this study was to investigate the association between two polymorphisms in the PON1 gene and statin responses in a south Brazilian population. DESIGN AND METHODS The study population included 433 dyslipidemic patients who were prescribed statins. Total cholesterol, triglyceride, HDL-C and LDL-C levels were measured in these patients both before and after approximately 6months of treatment with simvastatin/atorvastatin. Genotypes were assessed by real-time PCR for two PON1 polymorphisms, Q192R (rs662) and L55M (rs854560). RESULTS Baseline lipid levels were not associated with Q192R or L55M polymorphisms. For the Q192R (rs662) polymorphism, we observed that HDL-C goals were attained less often in patients with RR homozygosity than in Q allele carriers (χ(2) P=0.009, adjusted residual analysis P=0.003). For the L55M (rs854560) polymorphism, LL homozygotes were underrepresented among subjects that achieved the HDL-C goal (χ(2) P=0.026, adjusted residual analysis P=0.008). Analysis by univariate logistic regression confirmed that QQ/QR and MM/ML carriers had an increased chance of attaining HDL-C goals (OR=2.41, CI95%=1.32-4.40, P=0.004 and OR=1.68, CI95%=1.15-2.45, P=0.008). In a multivariate logistic analysis used to assess predictors of attaining an HDL-C goal>1.55mmol/L, we observed that gender (OR=1.71, CI95%=1.04-2.83, P=0.036), baseline HDL-C levels (OR=1.13, CI95%=1.10-1.16, P<0.001) and the QQ/QR+MM/ML genotypes increased the chance of achieving HDL-C goals (OR=2.81, CI95%=1.35-5.85, P=0.006). CONCLUSIONS The results of this study show that the Q192R (rs662) and L55M (rs854560) polymorphisms may play a role in interindividual variation in achievement of HDL-C goals in response to statins.
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Affiliation(s)
- Jéssica Aguiar de Souza
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Rio Grande do Sul, Brazil
| | - Angelica Menin
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Rio Grande do Sul, Brazil
| | - Luciana Otero Lima
- Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul-UFRGS, Rio Grande do Sul, Brazil
| | - Lisiane Smiderle
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Rio Grande do Sul, Brazil
| | - Mara Helena Hutz
- Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul-UFRGS, Rio Grande do Sul, Brazil
| | | | | | | | | | - Silvana Almeida
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Rio Grande do Sul, Brazil
| | - Marilu Fiegenbaum
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Rio Grande do Sul, Brazil.
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Smiderle L, Lima LO, Hutz MH, Van der Sand CR, Van der Sand LC, Ferreira MEW, Pires RC, Almeida S, Fiegenbaum M. Evaluation of sexual dimorphism in the efficacy and safety of simvastatin/atorvastatin therapy in a southern Brazilian cohort. Arq Bras Cardiol 2015; 103:33-40. [PMID: 25120083 PMCID: PMC4126759 DOI: 10.5935/abc.20140085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/17/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dyslipidemia is the primary risk factor for cardiovascular disease, and statins have been effective in controlling lipid levels. Sex differences in the pharmacokinetics and pharmacodynamics of statins contribute to interindividual variations in drug efficacy and toxicity. OBJECTIVE To evaluate the presence of sexual dimorphism in the efficacy and safety of simvastatin/atorvastatin treatment. METHODS Lipid levels of 495 patients (331 women and 164 men) were measured at baseline and after 6 ± 3 months of simvastatin/atorvastatin treatment to assess the efficacy and safety profiles of both drugs. RESULTS Women had higher baseline levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) compared with men (p < 0.0001). After treatment, women exhibited a greater decrease in plasma TC and LDL-C levels compared with men. After adjustment for covariates, baseline levels of TC and LDL-C influenced more than 30% of the efficacy of lipid-lowering therapy (p < 0.001), regardless of sex. Myalgia [with or without changes in creatine phosphokinase (CPK) levels] occurred more frequently in women (25.9%; p = 0.002), whereas an increase in CPK and/or abnormal liver function was more frequent in in men (17.9%; p = 0.017). CONCLUSIONS Our results show that baseline TC and LDL-C levels are the main predictors of simvastatin/atorvastatin therapy efficacy, regardless of sex. In addition, they suggest the presence of sexual dimorphism in the safety of simvastatin/atorvastatin. The effect of sex differences on receptors, transporter proteins, and gene expression pathways needs to be better evaluated and characterized to confirm these observations.
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Affiliation(s)
- Lisiane Smiderle
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Luciana O Lima
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mara Helena Hutz
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | - Silvana Almeida
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marilu Fiegenbaum
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Li Q, Huang P, He QC, Lin QZ, Wu J, Yin RX. Association between the CETP polymorphisms and the risk of Alzheimer's disease, carotid atherosclerosis, longevity, and the efficacy of statin therapy. Neurobiol Aging 2014; 35:1513.e13-23. [DOI: 10.1016/j.neurobiolaging.2013.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/30/2013] [Indexed: 11/28/2022]
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Association studies of several cholesterol-related genes (ABCA1, CETP and LIPC) with serum lipids and risk of Alzheimer's disease. Lipids Health Dis 2012. [PMID: 23181436 PMCID: PMC3532092 DOI: 10.1186/1476-511x-11-163] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives Accumulating evidence suggested that dysregulation of cholesterol homeostasis might be a major etiologic factor in initiating and promoting neurodegeneration in Alzheimer’s disease (AD). ATP-binding cassette transporter A1 (ABCA1), hepatic lipase (HL, coding genes named LIPC) and cholesteryl ester transfer protein (CETP) are important components of high-density lipoprotein (HDL) metabolism and reverse cholesterol transport (RCT) implicated in atherosclerosis and neurodegenerative diseases. In the present study, we will investigate the possible association of several common polymorphisms (ABCA1R219K, CETPTaqIB and LIPC-250 G/A) with susceptibility to AD and plasma lipid levels. Methods Case–control study of 208 Han Chinese (104 AD patients and 104 non-demented controls) from Changsha area in Hunan Province was performed using the PCR-RFLP analysis. Cognitive decline was assessed using Mini Mental State Examination (MMSE) as a standardized method. Additionally, fasting lipid profile and the cognitive testing scores including Wechsler Memory Scale (WMS) and Wisconsin Card Sorting Test (WCST) were recorded. Results and conclusions We found significant differences among the genotype distributions of these three genes in AD patients when compared with controls. But after adjusting other factors, multivariate logistic regression analysis showed only ABCA1R219K (B = −0.903, P = 0.005, OR = 0.405, 95%CI:0.217-0.758) and LIPC-250 G/A variants(B = −0.905, P = 0.018, OR = 0.405, 95%CI:0.191-0.858) were associated with decreased AD risk. There were significantly higher levels of high-density lipoprotein cholesterol (HDL-C) and apolipoproteinA-I in the carriers of KK genotype and K allele (P < 0.05), and B2B2 genotype of CETP Taq1B showed significant association with higher HDL-C levels than other genotypes (F = 5.598, P = 0.004), while -250 G/A polymorphisms had no significant effect on HDL-C. In total population, subjects carrying ABCA1219K allele or LIPC-250A allele obtained higher MMSE or WMS scores than non-carriers, however, no significant association was observed in AD group or controls. Therefore, this preliminary study showed that the gene variants of ABCA1R219K and LIPC-250 G/A might influence AD susceptibility in South Chinese Han population, but the polymorphism of CETPTaq1B didn't show any association in despite of being a significant determinant of HDL-C.
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Hubacek JA, Vrablik M. Effect of apolipoprotein E polymorphism on statin-induced decreases in plasma lipids and cardiovascular events. ACTA ACUST UNITED AC 2012; 26:13-20. [PMID: 21557673 DOI: 10.1515/dmdi.2011.107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hypercholesterolemia or dyslipidemia is an independent risk factor for cardiovascular disease and statins (inhibitors of a key enzyme of cholesterol synthesis, 3-hydroxymethyl glutaryl coenzyme A reductase) are the drugs of choice for decreasing plasma cholesterol. It has been estimated that genetic factors can explain 40%-60% of final cholesterol concentrations and approximately 70% of the efficacy of statin treatment. The gene most often analyzed in the context of statin efficacy is the gene for apolipoprotein E (APOE). This review summarizes evidence of the association between variations in the APOE gene locus and the response of plasma lipids to statin therapy. Although the results are not consistent, carriers of the APOE4 allele seems to be less responsive to statins than carriers of APOE2 and APOE3 alleles. This effect is partially context-dependent (gene-gender interactions; gene-nutrition and gene-smoking interactions have not yet been studied) and the absolute differences vary between different population groups.
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Cerda A, Genvigir FDV, Willrich MAV, Arazi SS, Bernik MMS, Dorea EL, Bertolami MC, Faludi AA, Hirata MH, Hirata RDC. Apolipoprotein E mRNA expression in mononuclear cells from normolipidemic and hypercholesterolemic individuals treated with atorvastatin. Lipids Health Dis 2011; 10:206. [PMID: 22074026 PMCID: PMC3247903 DOI: 10.1186/1476-511x-10-206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 11/10/2011] [Indexed: 11/25/2022] Open
Abstract
Background Apolipoprotein E (apoE) is a key component of the lipid metabolism. Polymorphisms at the apoE gene (APOE) have been associated with cardiovascular disease, lipid levels and lipid-lowering response to statins. We evaluated the effects on APOE expression of hypercholesterolemia, APOE ε2/ε3/ε4 genotypes and atorvastatin treatment in Brazilian individuals. The relationship of APOE genotypes and plasma lipids and atorvastatin response was also tested in this population. Methods APOE ε2/ε3/ε4 and plasma lipids were evaluated in 181 normolipidemic (NL) and 181 hypercholesterolemic (HC) subjects. HC individuals with indication for lowering-cholesterol treatment (n = 141) were treated with atorvastatin (10 mg/day/4-weeks). APOE genotypes and APOE mRNA in peripheral blood mononuclear cells (PBMC) were analyzed by TaqMan real time PCR. Results HC had lower APOE expression than NL group (p < 0.05) and individuals with low APOE expression showed higher plasma total and LDL cholesterol and apoB, as well as higher apoAI (p < 0.05). Individuals carrying ε2 allele have reduced risk for hypercholesterolemia (OR: 0.27, 95% I.C.: 0.08-0.85, p < 0.05) and NL ε2 carriers had lower total and LDL cholesterol and apoB levels, and higher HDL cholesterol than non-carriers (p < 0.05). APOE genotypes did not affect APOE expression and atorvastatin response. Atorvastatin treatment do not modify APOE expression, however those individuals without LDL cholesterol goal achievement after atorvastatin treatment according to the IV Brazilian Guidelines for Dyslipidemia and Atherosclerosis Prevention had lower APOE expression than patients with desirable response after the treatment (p < 0.05). Conclusions APOE expression in PBMC is modulated by hypercholesterolemia and the APOE mRNA level regulates the plasma lipid profile. Moreover the expression profile is not modulated neither by atorvastatin nor APOE genotypes. In our population, APOE ε2 allele confers protection against hypercholesterolemia and a less atherogenic lipid profile. Moreover, low APOE expression after treatment of patients with poor response suggests a possible role of APOE level in atorvastatin response.
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Affiliation(s)
- Alvaro Cerda
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Brazil.
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de Keyser CE, Eijgelsheim M, Hofman A, Sijbrands EJG, Maitland-van der Zee AH, van Duijn CM, Uitterlinden AG, Witteman JCM, Ch Stricker BH. Single nucleotide polymorphisms in genes that are associated with a modified response to statin therapy: the Rotterdam Study. THE PHARMACOGENOMICS JOURNAL 2010; 11:72-80. [PMID: 20195290 DOI: 10.1038/tpj.2010.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to investigate whether common variation in genes involved in lipid metabolism modify the effect of statins on serum total cholesterol concentration. Statin users were identified in the Rotterdam Study, a prospective population-based cohort study of subjects >55 years of age. We studied the association between single nucleotide polymorphisms (SNPs) in genes involved in lipid metabolism and total cholesterol response to statin therapy, using linear regression analysis and adjusting for potential confounders. Replication was performed in an independent extended cohort of the Rotterdam Study. Genotype data and total cholesterol concentrations after start of statin therapy were available for 554 newly started statin users. Two SNPs were associated with a significantly higher cholesterol concentration under statin therapy: SNP rs1532624 in the CETP gene (β: 0.141 mmol l(-1), P=0.004 per additional allele) and SNP rs533556 in the APOA1 gene (β: 0.138 mmol l(-1), P=0.005 per additional allele). In the replication sample, only the CETP rs1532624 SNP again showed a significant association. The SNPs were not related to baseline total cholesterol in non-statin users. In conclusion, we found that the CETP rs1532624 polymorphism is associated with cholesterol response to statin therapy in a cohort of elderly subjects in the general population.
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Affiliation(s)
- C E de Keyser
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Peters BJM, Klungel OH, de Boer A, Maitland-van der Zee AH. Genetic determinants of response to statins. Expert Rev Cardiovasc Ther 2009; 7:977-83. [PMID: 19673675 DOI: 10.1586/erc.09.83] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In developed countries, cardiovascular disease is one of the leading causes of death. Statins are abundantly prescribed to reduce the risk of coronary artery disease by lowering cholesterol. Genetic factors are thought to be partly responsible for the interindividual variation in the response to statins. This article reviews the most important studies conducted on pharmacogenetics of statins. Currently, there is no evidence to advocate pharmacogenetic testing before initiating therapy.
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Affiliation(s)
- Bas J M Peters
- Utrecht University, Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, PO Box 80082, 3508 TB, Utrecht, The Netherlands
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Zintzaras E, Kitsios GD, Triposkiadis F, Lau J, Raman G. APOE gene polymorphisms and response to statin therapy. THE PHARMACOGENOMICS JOURNAL 2009; 9:248-57. [PMID: 19529002 DOI: 10.1038/tpj.2009.25] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Published studies investigating the role of APOE gene on lipid response (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides) to statin treatment have reported inconsistent results. A meta-analysis was conducted to estimate the lipid response to statin treatment among APOE genetic variants (e2 carriers, e3e3 homozygotes and e4 carriers). Twenty-four studies were included in the meta-analyses. The pooled mean reduction (Delta mu) in TC from baseline was significant for all variants (e2 carriers: Delta mu=-27.7% (-32.5 to -22.8%), e3e3: Delta mu=-25.3% (-28.0 to -22.6%) and e4 carriers: Delta mu=-25.1% (-29.3 to -21.0%)). Significant changes in LDL-C, HDL-C and triglyceride levels were also noted for all genotypes, although these changes did not differ significantly among genotypic groups. There was significant heterogeneity among the studies. Given these non-significant effects of APOE genotypes on lipid responses, there is little reason to consider the use of APOE genetic testing for guiding treatment with statins.
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Affiliation(s)
- E Zintzaras
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.
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Nieminen T, Kähönen M, Viiri LE, Grönroos P, Lehtimäki T. Pharmacogenetics of apolipoprotein E gene during lipid-lowering therapy: lipid levels and prevention of coronary heart disease. Pharmacogenomics 2009; 9:1475-86. [PMID: 18855536 DOI: 10.2217/14622416.9.10.1475] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A non-optimal plasma concentration of lipids is among the major modifiable risk factors of atherosclerosis. Therefore, the prevention of cardiovascular disease by means of lipid-lowering therapy with statins and other agents is of great importance for patient groups where a lifestyle change, for example, diet modification, does not lead to adequately reduced lipid levels. The response of low-density-lipoprotein cholesterol (LDL-C) levels to statin therapy is highly variable. This is partly attributed to hereditary variation in genes involved in pharmacokinetics, pharmacodynamics and lipid metabolism. The pharmacogenetics of lipid-lowering therapy have been investigated for more than 40 different genes. The gene for apolipoprotein E (APOE) has been the most frequently studied, particularly regarding the epsilon2/epsilon3/epsilon4 polymorphism. Those with the epsilon4 allele seem to have the poorest and those with the epsilon2 allele the strongest response to statins with regards to LDL-C levels. In addition, the epsilon2 carriers may reach the LDL-C treatment goals more frequently than epsilon4 carriers. Few studies have investigated the interaction of the APOE epsilon2/epsilon3/epsilon4 polymorphism and lipid-lowering therapy in relation to the course of coronary heart disease; the results are contradictory and so far inconclusive. This review summarizes the pharmacogenetic findings related to the influence of APOE gene variation on lipid responses and the prevention of coronary heart disease during lipid-lowering therapy.
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Affiliation(s)
- Tuomo Nieminen
- Department of Pharmacological Sciences, University of Tampere Medical School, Tampere, Finland.
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Abstract
Although pharmacologic treatment for cholesterol reduction represents an advance in cardiovascular and atherosclerosis treatment, the benefits of such therapy are still limited because of interindividual variability in the response to these drugs. Disease severity, treatment adherence, physiologic conditions, biologic conditions, and the patient's genetic profile could be cited as important factors in the evaluation of interindividual variability. In regard to the latter consideration, three large groups of genes could be investigated: (i) genes that code for proteins involved in metabolism and/or drug transport, thereby influencing the pharmacokinetics of these compounds; (ii) genes that code for proteins involved in the mechanism of action and/or in the metabolic pathway of drug action, and which therefore influence pharmacodynamics; and (iii) genes that code for proteins involved in direct development of the disease or in intermediate phenotypes. In this review we discuss pharmacogenetic studies of the HMG-CoA reductase inhibitors (statins) and the implications of pharmacogenetic considerations for predicting treatment efficacy and reducing the adverse effects of these drugs. Once new studies have been performed and most of the genetic variability associated with drug action has been revealed, the great challenge will be to apply this knowledge in clinical medicine.
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Affiliation(s)
- Mara H Hutz
- Genetics Department, Biosciences Institute, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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Sousa MO, Corbella E, Alía P, Cámara J, Castro MJ, Pintó X, Navarro MA. [Lack of association between the APOE genotype and the response to statin treatment in patients with acute ischemic episodes]. Med Clin (Barc) 2008; 130:401-4. [PMID: 18394363 DOI: 10.1157/13117852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE APOE genotype has been shown to have an influence on lipid concentrations. However, its relation with response to lipid-lowering treatment is not well established. The aim of our work was to analyze whether this genotype is associated with changes in the lipid profile in response to statins treatment. PATIENTS AND METHOD A total of 222 consecutive patients with acute ischemic episodes and subjected to treatment with statins were included in a retrospective study. The patients' lipid profile was determined at the first visit to the Lipids Unit and after one year on a statin regime. APOE genotypes were determined by PCR-RFLP, and separated in three groups: E2 (E2 carriers), E4 (E4 carriers) and E3 (E3/E3). E2/E4 patients were not included in the study. RESULTS Relative frequencies of alleles epsilon2, epsilon3 and epsilon4 were 10.5%, 70.9% and 18.6% respectively. Significant differences among groups (p = 0.039) were observed for c-LDL concentrations. E2 group had lower c-LDL than E3 group (p = 0.017) and E4 group (p = 0.01). No significant differences in c-LDL, c-HDL and c-HDL/CT were observed among the three groups with regard to variation after statin treatment. CONCLUSION APOE genotype does not significantly affect the lipid response in patients with acute ischemic episodes after statin treatment.
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Affiliation(s)
- Marinez Oliveira Sousa
- Laboratorio de Bioquímica Hormonal y Génica, Hospital Universitario de Bellvitge, Barcelona, Spain.
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Hindorff LA, Lemaitre RN, Smith NL, Bis JC, Marciante KD, Rice KM, Lumley T, Enquobahrie DA, Li G, Heckbert SR, Psaty BM. Common genetic variation in six lipid-related and statin-related genes, statin use and risk of incident nonfatal myocardial infarction and stroke. Pharmacogenet Genomics 2008; 18:677-82. [PMID: 18622260 PMCID: PMC2736793 DOI: 10.1097/fpc.0b013e3283033528] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Genetic polymorphisms are associated with lipid-lowering response to statins, but generalizeability to disease endpoints is unclear. The association between 82 common single nucleotide polymorphisms (SNPs) in six lipid-related or statin-related genes (ABCB1, CETP, HMGCR, LDLR, LIPC, NOS3) and incident nonfatal myocardial infarction (MI) and ischemic stroke was analyzed according to current statin use and overall in a population-based case-control study (856 MI, 368 stroke, 2686 controls). METHODS Common SNPs were chosen from resequencing data using pairwise linkage disequilibrium. Gene-level analyses (testing global association within a gene) and SNP-level analyses (comparing the number of observed vs. expected associations across all genes) were performed using logistic regression, setting nominal statistical significance at P value of less than 0.05. RESULTS No gene-level interactions with statin use on MI or stroke were identified. Across all genes, two SNP-statin interactions on MI were observed (one ABCB1, one LIPC) and five interactions on stroke (one CETP, four LIPC). The strongest SNP-statin interaction was for synonymous CETP SNP rs5883 on stroke (P=0.008). Gene-level associations were present for LIPC and MI (P=0.026), but not other genes or outcomes. SNP-level associations included three SNPs with MI (one LDLR, two LIPC) and two SNPs with stroke (one CETP, one LDLR). The number of observed SNP associations was no greater than expected by chance. CONCLUSION Several potential novel associations or interactions of SNPs in ABCB1, CETP, LDLR, and LIPC with MI and stroke were identified; however, our results should be regarded as hypothesis generating until corroborated by other studies.
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Affiliation(s)
- Lucia A Hindorff
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA.
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Dullaart RPF, Sluiter WJ. Common variation in the CETP gene and the implications for cardiovascular disease and its treatment: an updated analysis. Pharmacogenomics 2008; 9:747-63. [DOI: 10.2217/14622416.9.6.747] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Human plasma contains cholesteryl ester transfer protein (CETP) which, besides other functions, enables the transfer of cholesteryl esters in plasma from high-density lipoproteins (HDL) towards triglyceride-rich lipoproteins, thereby contributing to lower HDL cholesterol. Variations in the CETP gene, including the intronic TaqIB polymorphism (rs708272), are common in the population. Although HDL cholesterol is approximately 10% higher in TaqIB B2B2 than in B1B1 carriers, the association of this polymorphism with cardiovascular disease has not been unequivocally established. We present an updated pooled analysis concerning the association of cardiovascular disease with the TaqIB polymorphism, including only studies that predominantly comprise Caucasian subjects. The distribution of this CETP genotype was observed to be different in population-based studies (n = 10,526) compared with studies in populations selected by high cardiovascular risk (n = 10,947), with B2B2 carriers being less frequent among cases from high-risk populations compared with cases from population-based studies (p = 0.0009 for the difference in genotype distribution). In population-based studies, the odds ratio (OR) for cardiovascular disease was found to be 1.45 (95% CI: 1.07–1.95) in B2B2 compared with B1B1 carriers, contrasting the lower OR of 0.84 (95% CI: 0.74–0.96) in B2B2 versus B1B1 carriers from high-risk populations. Thus, it is possible that in the general population, the B2 allele is associated with higher cardiovascular risk, despite higher HDL cholesterol. Our analysis agrees with the contention that selection towards a lower frequency of B2B2 homozygotes may have occurred in selected populations, which would result in a apparently protective effect of the B2 allele when determined in high-risk populations. We also evaluated whether the TaqIB polymorphism would predict efficacy of lipid-lowering treatment with respect to plasma lipids and cardiovascular outcome, but the results of published studies were contradictory. Likewise, no definite conclusion can be made at present concerning the effect of this CETP polymorphism on the lipid response to diet intervention.
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Affiliation(s)
- Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Endocrinology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Goulas A, Kosmidou M, Hatzitolios AI, Molyva D, Fidani L, Giannopoulos S, Mirtsou V. Glutathione S-Transferase Null and Cholesteryl Ester Transfer Protein TaqI B Polymorphisms and Lipid Response to Atorvastatin in Greek Dyslipidaemic Patients. Basic Clin Pharmacol Toxicol 2008; 102:559-62. [DOI: 10.1111/j.1742-7843.2008.00220.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Apolipoprotein E genotypes are associated with lipid-lowering responses to statin treatment in diabetes: a Go-DARTS study. Pharmacogenet Genomics 2008; 18:279-87. [PMID: 18334912 DOI: 10.1097/fpc.0b013e3282f60aad] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Apolipoprotein E (APOE) genotypes have been associated with variations in plasma-lipid levels and with response to statins, although the influence of APOE on the response to statins remains controversial, especially in patients with diabetes. We sought to evaluate the association of the APOE genotype with the low-density lipoprotein cholesterol (LDLc)-lowering response to statins, in a large population-based cohort of patients with diabetes. METHODS AND RESULTS A total of 1383 patients, commencing statins between 1990 and 2006, were identified from the Genetics of Diabetes Audit and Research in Tayside Scotland database. Statin response was determined both by the minimum LDLc achieved, and by the failure of the patients to reach a clinical target LDLc (< or =2 mmol/l). APOE genotype and potential confounding covariates were entered into the linear and logistic regression models. RESULTS We found an association of APOE genotypes with both baseline and treatment responses. E2 homozygotes achieved lower LDLc levels (mean 0.6; confidence interval: 0.1-1.1 mmol/l) than E4 homozygotes (mean 1.7; confidence interval: 1.4-1.9 mmol/l; P=2.96 x 10). Minimum LDLc was associated by a linear trend with genotype. This relationship remained statistically significant after adjustment for baseline LDLc, adherence, duration, dose, smoking, and age. None of the E2 homozygotes failed to reach the target LDLc, compared with 32% of the E4 homozygotes (P=5.3 x 10). CONCLUSION This study demonstrates the potential clinical value of the APOE genotype as a robust marker for LDLc responses to statin drugs, which might contribute to the identification of a particularly drug-resistant subgroup of patients. This marker provides information over and above baseline lipid levels.
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Abstract
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) are among the most commonly prescribed drugs worldwide. On average, statins improve lipid profiles and have been shown to have ancillary beneficial effects on inflammation, platelet activity, and endothelial function. However, variability in drug response exists regardless of the measured phenotype, and genetic variability may be a contributing factor. Recently, there has been an interesting shift in statin pharmacogenetic studies. Novel study designs have been employed and nontraditional candidate genes have been investigated in relation to both lipid and nonlipid responses to statins. This review outlines earlier pharmacogenetic studies and highlights newly published findings that expand on previous work. Furthermore, a framework is provided in which the necessary next steps in research are described, with the ultimate goal of translating pharmacogenetic findings into clinically meaningful changes in patient care.
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Affiliation(s)
- Issam Zineh
- University of Florida College of Pharmacy, Department of Pharmacy Practice and Center for Pharmacogenomics, Gainesville, FL 32610, USA.
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Dergunov AD, Visvikis-Siest S, Siest G. Statins as effectors of key activities involved in apoE-dependent VLDL metabolism: Review and hypothesis. Vascul Pharmacol 2008; 48:70-5. [DOI: 10.1016/j.vph.2007.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 10/31/2007] [Accepted: 12/05/2007] [Indexed: 11/26/2022]
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Hofnagel O, Luechtenborg B, Weissen-Plenz G, Robenek H. Statins and foam cell formation: Impact on LDL oxidation and uptake of oxidized lipoproteins via scavenger receptors. Biochim Biophys Acta Mol Cell Biol Lipids 2007; 1771:1117-24. [PMID: 17690011 DOI: 10.1016/j.bbalip.2007.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 06/18/2007] [Accepted: 06/25/2007] [Indexed: 10/23/2022]
Abstract
The uptake of oxidized lipoproteins via scavenger receptors and the ensuing formation of foam cells are key events during atherogenesis. Foam cell formation can be reduced by treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins). The efficacy of statins is evidently due not only to their cholesterol-lowering properties, but also to lipid-independent pleiotropic effects. This review focuses on lipid-independent pleiotropic effects of statins that influence foam cell formation during atherogenesis, with special emphasis on oxidative pathways and scavenger receptor expression.
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Affiliation(s)
- Oliver Hofnagel
- Department of Cell Biology and Ultrastructure Research, Leibniz Institute of Arteriosclerosis Research at the University of Münster, and Department of Cardiology and Angiology, Hospital of the University of Münster, Germany.
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Christidis DS, Liberopoulos EN, Kakafika AI, Miltiadous GA, Cariolou M, Ganotakis ES, Mikhailidis DP, Elisaf MS. The effect of apolipoprotein E polymorphism on the response to lipid-lowering treatment with atorvastatin or fenofibrate. J Cardiovasc Pharmacol Ther 2007; 11:211-21. [PMID: 17056835 DOI: 10.1177/1074248406293732] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although the effect of apolipoprotein E gene polymorphism on the response to treatment with statins has been studied, the results are conflicting. Moreover, little is known about the possible effect of apolipoprotein E alleles on the response to treatment with fibrates. The purpose of this study was to evaluate the effect of apolipoprotein E polymorphism on lipid-lowering response to treatment with atorvastatin and fenofibrate in patients with different types of dyslipidemia. The study population included 136 patients with heterozygous familial hypercholesterolemia (type IIA dyslipidemia) treated with atorvastatin (20 mg/day) and 136 patients with either primary hypertriglyceridemia (type IV dyslipidemia) or mixed hyperlipidemia (type IIB dyslipidemia) treated with micronized fenofibrate (200 mg/day). Overall, no significant associations were detected between apolipoprotein E genotype and response to treatment with atorvastatin. In patients treated with fenofibrate, significant associations were noted between apolipoprotein E genotype and changes in apolipoprotein B, apolipoprotein E and triglyceride levels. Specifically, in apolipoprotein E2, apolipoprotein E3, and apolipoprotein E4 individuals, apolipoprotein B reductions were 22%, 17%, and 8%, respectively (P = .003); apolipoprotein E reductions were 45%, 20%, and 15%, respectively (P = .006); whereas triglyceride reductions reached 53%, 36%, and 33%, respectively (P = .033). In conclusion, apolipoprotein E genotype had no significant effect on the response to treatment with atorvastatin in patients with heterozygous familial hypercholesterolemia, but in patients with primary hypertriglyceridemia or mixed hyperlipidemia, there was a clear association between apolipoprotein E genotype and response to treatment with fenofibrate.
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Affiliation(s)
- Dimitrios S Christidis
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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