Mega, J. L., Morrow, D. A., Brown, A., Cannon, C. P., Sabatine, M. S. Identification of genetic variants associated with response to statin therapy Arteriosclerosis, thrombosis, and vascular biology. 2009;29(9):1310-5.

OBJECTIVE: The purpose of this study was to test the association between polymorphisms in genes involved in either LDL cholesterol (LDL-C) metabolism or statin pharmacokinetics and LDL-C reduction with statins.

METHODS AND RESULTS: 49 tagging and candidate polymorphisms in 9 genes were genotyped in 1507 post-ACS subjects randomized to atorvastatin or pravastatin. Two polymorphisms (rs7412, rs429358) that define the epsilon2, epsilon3, and epsilon4 isoforms of apolipoprotein E were significantly associated with percent reduction in LDL-C with atorvastatin (epsilon2 carriers 53.8%, epsilon3/epsilon3 48.1%, and epsilon4 carriers 46.4%, respectively, P=0.00039) and replicated in the pravastatin arm (epsilon2 carriers 22.1%, epsilon3/epsilon3 21.8%, and epsilon4 carriers 16.6%, respectively, P=0.00038). The proportion of subjects achieving an LDL-C < or =70 mg/dL at day 30 was higher for epsilon2 than epsilon4 carriers (P=1.3 x 10(-5)). In the pravastatin group, the triallelic rs2032582 variant (G2677T/A) in ABCB1 was associated with the percent reduction in LDL-C (GG 23.3%, non-G heterozygote 20.3%, and non-G homozygote 17.4%, P=0.042).

CONCLUSIONS: Carriers of APOE epsilon2 versus epsilon4 had significantly greater LDL-C reduction with atorvastatin and with pravastatin, and more frequently achieved a guideline-recommended LDL-C < or =70 mg/dL. Polymorphisms in triallelic G2677T/A variant in ABCB1 were associated with the degree of LDL-C lowering with pravastatin.