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Gene Behind Serious Statin Risk

Muscle Condition From Cholesterol Drugs Linked to Gene Variant
By
WebMD Health News
Reviewed by Louise Chang, MD

Gene Link Statins Myopathy

Aug. 20, 2008 -- A variant gene causes more than 60% of cases of a serious side effect of cholesterol-lowering statin drugs -- muscle pain and weakness.

Statin drugs -- Lipitor, Pravachol, Crestor, Lescol, Mevacor, and Zocor -- are considered remarkably safe. But one in every 10,000 patients per year develops drug-related muscle trouble. Very rarely, this myopathy leads to muscle breakdown and fatal kidney failure.

Oxford University researcher Rory Collins, MB, and the SEARCH Collaborative Group performed genome-wide scans of heart attack survivors taking high doses (80 mg/day) of Zocor in a large-scale clinical trial. They compared the 98 patients who developed myopathy with 98 patients who did not.

"We provide compelling evidence that at least one common variant in the SLCO1B1 gene substantially alters the risk of [Zocor]-induced myopathy," Collins and colleagues conclude. "These findings are likely to apply to other statins because myopathy is a class effect, and SLCO1B1 polymorphisms affect the blood levels of several statins."

The gene variant is relatively common. It alters the function of a gene that regulates drug uptake in the liver. People who inherit two copies of the gene had a 17-fold increased risk of muscle problems when taking high doses of Zocor. Those with just a single copy had a 4.5-fold increased risk.

Collins and colleagues suggest that before starting high-dose statin treatment, patients may benefit from genetic testing to see whether they are at risk of side effects.

Yusuke Nakamura, MD, PhD, director of the Human Genome Center at the University of Tokyo, agrees.

In an editorial accompanying the Collins team's report in the Aug. 21 issue of the New England Journal of Medicine, Nakamura suggests that avoiding high doses of statins in people who carry the gene could reduce statin-related muscle problems by 60%.

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Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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