Niharika Koppolu & Miley Nguyen, PharmD, RPh
Have YOU EVER WONDERED…why statins don’t work the same for every woman?
- Hormonal and physiological factors affect statin metabolism in women, leading to higher rates of side effects and discontinuation
- Higher obesity rates and menopause-related lipid changes increase dyslipidemia and cardiovascular risk in women
- Pharmacogenomics enables personalized statin therapy to reduce adverse effects and support safer, more effective cholesterol management in women
The Challenge
Statins are the first-line treatment for high cholesterol, but their metabolism in women is affected by hormonal and physiological factors.
- Women have a higher prevalence of obesity than men, particularly between the ages of 20 and 59, which contributes to an increased risk of dyslipidemia, a common and clinically significant comorbidity closely linked to obesity. (Gheorghe et al., 2020).
- In pre-menopausal women, higher estrogen levels help maintain a heart-healthy balance by lowering low-density lipoprotein(LDL) and raising the beneficial high-density lipoprotein (HDL), supporting better cholesterol metabolism. As estrogen declines during peri-menopause and menopause, leading to increased LDL and reduced HDL levels, which together contribute to a higher risk of cardiovascular disease (Gheorghe et al., 2020).
- Women are more likely than men to discontinue statin therapy due to side effects, especially muscle-related symptoms. Studies show that 31% of women report new or worsening muscle discomfort, compared to 26% of men, highlighting a greater susceptibility to statin-associated muscle toxicity (Kralis et al., 2017).
Benefits & Real-World Applications of PGx
Pharmacogenomics offers a personalized solution to sex-based differences in statin therapy by identifying genetic risks for adverse drug reactions.
- SLCO1B1 is a gene that encodes the hepatic transporter protein OATP1B1, which plays a key role in the excretion of various statins. Genetic variants that reduced function of this transporter can lead to increased plasma concentrations of certain statins, raising the risk for dose-dependent adverse effects, such as statin-associated muscle symptoms. (CPIC guideline, 2022)
- Reduced-function variants in SLCO1B1 are recognized as clinically relevant in guiding statin therapy. Patients with these variants may benefit from dosing adjustments or alternative statins to help minimize the risk of adverse effects, particularly muscle-related symptoms. Incorporating SLCO1B1 status into treatment decisions supports a more individualized and safer approach to cholesterol management (CPIC guideline, 2022; U.S. FDA, 2024)
Conclusion
PGx helps bridge this gap by guiding treatment selection based on an individual’s genetic makeup.
- Pharmacogenomics offers a valuable tool for enhancing the safety and effectiveness of statin therapy. By identifying genetic markers such as SLCO1B1, healthcare professionals can better account for individual variability and sex-specific risks.
Learn more about UGenome.
Personalized Medication Service, ProPEx, or contact UGenome. You can also find case studies for UGenome’s bioinformatics services Metabolite Identification, Bone Metastasis Risk Analysis in Breast Cancer, Survival Analysis with gene signatures in cancer
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