on behalf of the SPACE ROCKET Trial GroupBackground-Pharmacogenetics aims to maximize benefits and minimize risks of drug treatment. Our objectives were to examine the influence of common variants of hepatic metabolism and transporter genes on the lipid-lowering response to statin therapy. Methods and Results-The Genetic Effects On STATins (GEOSTAT-1) Study was a genetic substudy of Secondary Prevention of Acute Coronary Events-Reduction of Cholesterol to Key European Targets (SPACE ROCKET) (a randomized, controlled trial comparing 40 mg of simvastatin and 10 mg of rosuvastatin) that recruited 601 patients after myocardial infarction. We genotyped the following functional single nucleotide polymorphisms in the genes coding for the cytochrome P450 (CYP) metabolic enzymes, CYP2C9*2 (430CϾT), CYP2C9*3 (1075AϾC), CYP2C19*2 (681GϾA), CYP3A5*1 (6986AϾG), and hepatic influx and efflux transporters SLCO1B1 (521TϾC) and breast cancer resistance protein (BCRP; 421CϾA). We assessed 3-month LDL cholesterol levels and the proportion of patients reaching the current LDL cholesterol target of Ͻ70 mg/dL (Ͻ1.81 mmol/L). An enhanced response to rosuvastatin was seen for patients with variant genotypes of either CYP3A5 (Pϭ0.006) or BCRP (Pϭ0.010). Furthermore, multivariate logistic-regression analysis revealed that patients with at least 1 variant CYP3A5 and/or BCRP allele (nϭ186) were more likely to achieve the LDL cholesterol target (odds ratio: 2.289; 95% CI: 1.157, 4.527; Pϭ0.017; rosuvastatin 54.0% to target vs simvastatin 33.7%). There were no differences for patients with variants of CYP2C9, CYP2C19, or SLCO1B1 in comparison with their respective wild types, nor were differential effects on statin response seen for patients with the most common genotypes for CYP3A5 and BCRP (nϭ415; odds ratio: 1.207; 95% CI: 0.768, 1.899; Pϭ0.415).
Conclusion-The