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Tuesday, 4 November 2014
UK breakthrough for statins patients
A SIMPLE test which can reveal who will best respond to life-saving statins is a step closer after a major breakthrough by British scientists.
Experts at Queen Mary University of London hope their discovery of two new genetic variants which influence how "bad" cholesterol levels respond to statins could help save thousands of lives every year.
At least eight million people in Britain are already taking statins but recent updated NHS advice means they could soon be taken by as many as 17 million adults to prevent heart problems.
The "miracle" pills have been shown to lower bad cholesterol levels by up to 55 per cent, making them a highly effective method of reducing risk of heart disease.
However, despite this success, many patients can suffer side effects and for others, the drugs simply do not work to bring down their cholesterol to safe levels.
Now, the team of scientists say their genetic breakthrough will help pinpoint ways to make statins more effective for individual patients.
One of the new variants has been shown to boosts statin response and the second, which is thought to have a role in the uptake of statins by the liver, decreases the effects of the drug.
Researcher Dr Michael Barnes, from QMUL, said: "Statins are one of the safest and most effective drugs in clinical use. Although all share a common target, some statins are more effective than others in different individuals.
"This study highlights a network of interacting genes which may individually or collectively influence the way that statins act in the body. In the future, this information could help us to select the most effective statin for each patient."
The study, published in the journal Nature Communications, analysed more than 40,000 individuals on statin treatment.
It is the largest study to date looking at genetic variants influencing a patient's response to statins and involved analysing data from six randomised clinical trials and 10 observational studies to look for genetic variants influencing patients' response to the pills.
Together with a number of universities around the world, the researchers validated their findings in a further 22,318 individuals and found two new common genetic variants which significantly affected the degree to which bad cholesterol was lowered during statin treatment.
In addition to identifying two new genetic variants, the study also confirmed two previously-identified genetic variants thought to impact statin response.
The effects of all four of these variants collectively account for about 5 per cent of the variation in the individual response to statins.
It is hoped these findings will enhance understanding of the biological mechanisms underlying the response of bad cholesterol to the drugs.
Lead author Professor Mark Caulfield, said: "This study marks an important step toward understanding how genetic variations influence statin response. However, further research is needed to find out how we can apply this in care of patients receiving statins.
"We must build up a bigger picture of the genetic variation that predicts statin response. Only then will we be in a position to tell whether testing for these genetic variants is of benefit to patients who take statin therapy."
Co-author Dr Helen Warren, added: "These results really show the benefit of conducting large-scale meta-analyses with a partnership of international researchers. We hope our ongoing research will provide further insight into the genetic causes of variable treatment response."
Jeremy Pearson, associate medical director at the British Heart Foundation, said: "Statins are highly effective at lowering 'bad' cholesterol and reducing heart attacks.
"These findings increase our understanding of how the body regulates cholesterol levels and may help provide clues for treatments in the future.
"It also shows that a simple personal genetic test could be used to predict how effective statin treatment would be.
"However, as these genes only account for a small percentage of the difference in patients' response to statins, and cholesterol levels are already monitored to assess their effectiveness, a test may not add any clinical benefit."
Earlier this year the National Institute for Health and Care Excellence updated its statins guidance to lower the threshold for those eligible to take the pills.
The pills were being offered to people who have a 20 per cent risk of developing cardiovascular disease within 10 years.
But the new rule say the NHS should lower this threshold to include people with just a 10 per cent risk.
This could see an additional 4.5 million patients offered the drugs, bringing the total of all eligible people to 17 million - around 40 per cent of the adult population of England.
If everyone eligible took the drugs, Nice estimates that between 20,000 and 50,000 deaths could be prevented every year.
The pills cost just a few pence a day per patient.
But some doctors have expressed concern that the new rules will mean they are given needlessly to healthy people.
There have been suggestions that statins can cause worrying side effects.
Data from the Health and Social Care Information Centre shows that last year 66.8 million doses of statins and other cholesterol-lowering drugs were dispensed in England - almost treble the 2003 figure of 22.7 million.