Dan (58 years old) is a hedonist, and he loves a good glass of vine and a nice dinner with friends and family. For more than 10 years, Dan has been heavyset and has had high cholesterol and elevated blood pressure. Six months ago, he was diagnosed with diabetes 2. He is being treated with cholesterol-, blood pressure-, and blood sugar lowering drugs. He suffers from severe side effects from his medication, an uncomfortable feeling in his stomach, general muscle pain and feels tired. Dan wants to know if there are alternative drugs that might be better for him.
Dan´s doctor has several drugs to choose from, but Dan is concerned because his brother developed severe muscle pain and weakness when taking certain statins. His brother went through a long series of prescriptions, blood tests and appointments before the right drug was found.
Dan decides to take a pharmacogenetic test offered to him through his healthcare insurance service. The test shows intermediate activity of SLCO1B1, meaning that there is a risk of higher concentrations of statins in the blood, leading to a higher risk of side effects. Dan and his doctor change to a statin drug with a low risk of side effects.
Most medications exhibit an inter-individual variability in their efficacy. A considerable part of this variability is due to inherited gene variations.
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Statins are a cornerstone of the treatment and prevention of atherosclerotic cardiovascular disease and among the most prescribed medications. However, adverse drug reactions may result in significant cost and can lead to nonadherence and discontinuation of therapy. Statin-associated muscle symptoms constitute the most commonly reported adverse effect.
Review of the relevant clinical research on polymorphisms in several key genes that affect statin pharmacokinetics (eg, transporters and metabolizing enzymes), statin efficacy and end-organ toxicity highlights several promising pharmacogenomic candidates. However, SLCO1B1, 521C is currently the only clinically relevant pharmacogenetic test regarding statin toxicity,
Ref: Gerd Schmitz et al. Pharmacogenomics and Pharmacogenetics of Cholesterol-Lowering Therapy. Clinical Chemistry and Laboratory Medicine, 2005 vol 41: issue 4.
We are all different
The practice of medicine has always been about treating each person as an individual patient. For a long time, clinicians have observed that patients with the same diagnosis may respond differently to the same medical treatment.
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