March 4th, 2015
Genetic Screening Test Could Identify People More Likely To Benefit From Statins
Larry Husten, PHD
A genetic risk score can identify people at high risk for coronary disease, according to a new report in the Lancet. The score can also help find those who are most likely to benefit from statin therapy.
The genetic risk score, derived from 27 single-nucleotide polymorphisms (SNPs), successfully identified individuals at highest risk for a cardiac event within a study population of some 50,000 people who participated in a large community-based cohort study or one of four randomized controlled statin trials. People in the highest quintile of genetic risk had a 70% greater risk for coronary heart disease than those in the bottom quintile. Similarly, statin therapy resulted in the highest relative and absolute risk reductions in those at highest risk.
“There is ongoing debate over which individuals should be allocated statin therapy to prevent a first heart attack,” said the co-first author of the study, Nathan O. Stitziel, in a press release. “Some have said we should be treating more people, while others say we need to treat fewer. As an example of precision medicine, another approach is to identify people at high risk and preferentially prescribe statin therapy to those individuals. Genetics appears to be one way to identify high-risk patients.”
3 Responses to “Genetic Screening Test Could Identify People More Likely To Benefit From Statins”
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I would like this testing to be more widely available AND affordable. I think it would help me decide which of my patients with high cholesterol AND intolerant of statins need to be pushed to retry statins.
Am I misreading this? A 70% increase from the lowest quartile to the highest is clinically insignificant. No help with decision making in half of the subjects and only a small fraction of the stratification we get from coronary calcium imaging which is inexpensive and readily available.
I agree with Dr. Blanchet. In fact the absolute values of risk reduction must be considered to identify the extent of the benefits of statin therapy. Therefore, taking into account the data of the JUPITER Study (see Table 2 of the cited report in “Lancet”) to avoid an event, 100 people in the low genetic risk group would need to receive statin therapy during 6,6 years, in the intermediate risk group during 4,2 years, and in the high risk group during 2,5 years.
Because any therapy must be benefic to the whole human being, and not only for a specific part of it, and due to known side-effects of statins I wonder if such a low absolute benefit of statin therapy is not annulled or even outshined by potential harms in other parts of the body?