Genetically Guided Statin Therapy
Technical Report,01 Jan 2013,31 Jul 2016
Duke University Durham
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Statins are important and effective medications to lower cholesterol and prevent cardiovascular disease. Long-term adherence is a challenge, due, in part, to statin intolerance due to musculoskeletal side effects. In objective 1, we randomly assigned 159 primary care patients with statin intolerance not prescribed statins to either genotype-guided statin therapy GGST or usual care. GGST patients and their providers received 5 genetic risk information about statin side effects and genotype-specific statin prescription recommendations. Patients in the usual care arm received general information regarding statin risk and prescriptions. The outcomes measured at 3 and 8 months were statin reinitiation, low-density lipoprotein cholesterol LDLc, and statin adherence using the validated Morisky Medication Adherence Scale. In primary care patients with statin intolerance, SLCO1B1 GGST is effective in lowering LDLc compared to usual care 131.9 - 42.0 vs. 144.4 - 43.0, p0.041. GGST, however, did not improve statin adherence in those who reinitiated statin therapy. In objective 2, we used electronic medical record billing, laboratory, and pharmacy data to build and validate a predictive model that identifies patients who will be nonadherent to statin therapy. The overall accuracy of this model as assessed by the area under the receiver operating characteristics curve was 0.81.