Characterization of statin dose response in electronic medical records

Clin Pharmacol Ther. 2014 Mar;95(3):331-8. doi: 10.1038/clpt.2013.202. Epub 2013 Oct 4.

Abstract

Efforts to define the genetic architecture underlying variable statin response have met with limited success, possibly because previous studies were limited to effect based on a single dose. We leveraged electronic medical records (EMRs) to extract potency (ED50) and efficacy (Emax) of statin dose-response curves and tested them for association with 144 preselected variants. Two large biobanks were used to construct dose-response curves for 2,026 and 2,252 subjects on simvastatin and atorvastatin, respectively. Atorvastatin was more efficacious, was more potent, and demonstrated less interindividual variability than simvastatin. A pharmacodynamic variant emerging from randomized trials (PRDM16) was associated with Emax for both. For atorvastatin, Emax was 51.7 mg/dl in subjects homozygous for the minor allele vs. 75.0 mg/dl for those homozygous for the major allele. We also identified several loci associated with ED50. The extraction of rigorously defined traits from EMRs for pharmacogenetic studies represents a promising approach to further understand the genetic factors contributing to drug response.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Alleles
  • Atorvastatin
  • Cholesterol, LDL / blood
  • Cohort Studies
  • Databases, Factual
  • Dose-Response Relationship, Drug
  • Electronic Health Records*
  • Genotype
  • Heptanoic Acids / administration & dosage
  • Heptanoic Acids / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hyperlipidemias / drug therapy*
  • Hyperlipidemias / genetics*
  • Lipid Metabolism / drug effects
  • Lipid Metabolism / genetics
  • Lipids / blood
  • Phenotype
  • Polymorphism, Single Nucleotide
  • Pyrroles / administration & dosage
  • Pyrroles / therapeutic use
  • Randomized Controlled Trials as Topic
  • Simvastatin / administration & dosage
  • Simvastatin / therapeutic use

Substances

  • Cholesterol, LDL
  • Heptanoic Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipids
  • Pyrroles
  • Atorvastatin
  • Simvastatin