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Genetically guided statin therapy on statin perceptions, adherence, and cholesterol lowering: a pilot implementation study in primary care patients.

Li JH, Joy SV, Haga SB, Orlando LA, Kraus WE, Ginsburg GS, Voora D - J Pers Med (2014)

Bottom Line: 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.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 of SLCO1B1*5 results and recommendations is feasible in the primary care setting.

View Article: PubMed Central - PubMed

Affiliation: Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA. josephine.li@dm.duke.edu.

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 of SLCO1B1*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.

No MeSH data available.


Association of GGST with subject-reported statin utilization. Individuals receiving GGST had a higher subject-reported statin utilization (47%) following genotyping compared to control subjects (15%) over a one-year period. GGST = genotype guided statin therapy.
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jpm-04-00147-f003: Association of GGST with subject-reported statin utilization. Individuals receiving GGST had a higher subject-reported statin utilization (47%) following genotyping compared to control subjects (15%) over a one-year period. GGST = genotype guided statin therapy.

Mentions: Compared to control subjects who were followed for one year in the same clinic, GGST subjects had a higher proportion of new statin prescriptions written by their primary care physician at four months (55% versus 20%, p < 0.001, Figure 2). We performed exploratory analysis among patients who received a new statin, looking at the proportion of prescriptions that were rosuvastatin or pravastatin. Of the nine carriers in the intervention group who received a new prescription, eight received either rosuvastatin or pravastatin (89%). Twelve of the 23 noncarriers (52%) who received a new statin prescription were restarted on either rosuvastatin/pravastatin. Within the control group, four of 12 (33%) received a new prescription of rosuvastatin/pravastatin. Compared to controls, GGST subjects had higher subject-reported statin usage (47% versus 15%, p < 0.001, Figure 3). Both associations remained statistically significant (p = 0.002 and p = 0.004, respectively) after adjusting for NCEP goals at baseline. In 39 GGST subjects with pre- and post-GGST LDL-c, we observed a 12.4 ± 45.4 mg/dL decrease over a one-year follow-up (p = 0.10, Figure 4). In comparison, in 34 control subjects with available LDL-c at baseline and at one-year follow-up, there was a 6.3 ± 37.8 mg/dL increase in LDL-c (p = 0.34). Compared to controls, GGST subjects had a decrease in LDL-c over the duration of follow-up (p = 0.059). These observations were marginally attenuated (p = 0.08) after adjusting for NCEP goals at baseline.


Genetically guided statin therapy on statin perceptions, adherence, and cholesterol lowering: a pilot implementation study in primary care patients.

Li JH, Joy SV, Haga SB, Orlando LA, Kraus WE, Ginsburg GS, Voora D - J Pers Med (2014)

Association of GGST with subject-reported statin utilization. Individuals receiving GGST had a higher subject-reported statin utilization (47%) following genotyping compared to control subjects (15%) over a one-year period. GGST = genotype guided statin therapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263970&req=5

jpm-04-00147-f003: Association of GGST with subject-reported statin utilization. Individuals receiving GGST had a higher subject-reported statin utilization (47%) following genotyping compared to control subjects (15%) over a one-year period. GGST = genotype guided statin therapy.
Mentions: Compared to control subjects who were followed for one year in the same clinic, GGST subjects had a higher proportion of new statin prescriptions written by their primary care physician at four months (55% versus 20%, p < 0.001, Figure 2). We performed exploratory analysis among patients who received a new statin, looking at the proportion of prescriptions that were rosuvastatin or pravastatin. Of the nine carriers in the intervention group who received a new prescription, eight received either rosuvastatin or pravastatin (89%). Twelve of the 23 noncarriers (52%) who received a new statin prescription were restarted on either rosuvastatin/pravastatin. Within the control group, four of 12 (33%) received a new prescription of rosuvastatin/pravastatin. Compared to controls, GGST subjects had higher subject-reported statin usage (47% versus 15%, p < 0.001, Figure 3). Both associations remained statistically significant (p = 0.002 and p = 0.004, respectively) after adjusting for NCEP goals at baseline. In 39 GGST subjects with pre- and post-GGST LDL-c, we observed a 12.4 ± 45.4 mg/dL decrease over a one-year follow-up (p = 0.10, Figure 4). In comparison, in 34 control subjects with available LDL-c at baseline and at one-year follow-up, there was a 6.3 ± 37.8 mg/dL increase in LDL-c (p = 0.34). Compared to controls, GGST subjects had a decrease in LDL-c over the duration of follow-up (p = 0.059). These observations were marginally attenuated (p = 0.08) after adjusting for NCEP goals at baseline.

Bottom Line: 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.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 of SLCO1B1*5 results and recommendations is feasible in the primary care setting.

View Article: PubMed Central - PubMed

Affiliation: Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA. josephine.li@dm.duke.edu.

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 of SLCO1B1*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.

No MeSH data available.