Pathway Statin Pathway, Pharmacodynamics

Genes involved in mediating statin effects on hepatic cholesterol metabolism and consequent effects on plasma lipoprotein transport.
Statin Pathway, Pharmacodynamics
abca1 abcg5 fdft1 abcg8
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Statins inhibit endogenous cholesterol production by competitive inhibition of HMG-CoA reductase (HMGCR), the enzyme that catalyzes conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. This pathway delineates genes involved in statin pharmacogenomics, including genes involved in mediating the pharmacodynamic (PD) effects of statins on plasma lipoprotein metabolism and those involved in the pharmacokinetics (PK) effects of the drug transport and metabolism.

The statin PD view depicts the effects of inhibition of HMG CoA reductase on major aspects of hepatic cholesterol metabolism, and selected gene products that can modulate the effects of statins on metabolism and transport of plasma lipoproteins that affect atherosclerosis and cardiovascular disease risk.

The statin PK view depicts a generalized view of the pharmacokinetics of this drug class, representing the superset of all genes with a reported influence on statin transport and metabolism. Statins are dosed orally and enter the systemic circulation through intestinal cells both passively and by active transport via the ABC and SLC gene family transporters. The major organs of metabolism and elimination include the liver and, to a lesser extent, the kidney. Metabolism is catalyzed by CYP and UGT gene family enzymes. The main pathway of elimination is ABC transporter mediated biliary excretion.

The pharmacokinetics of individual statin drugs are influenced by their hydrophobicity. The more hydrophilic compounds, pravastatin in particular, require active transport into the liver, are less metabolized by the cytochrome P450 (CYP) family, and exhibit more pronounced active renal excretion, while the less hydrophilic compounds are transported by passive diffusion and are better substrates for both CYP enzymes and transporters involved in biliary excretion. Although simvastatin and lovastatin are both given as lactone prodrugs and converted to the active beta-hydroxy form, the mechanism for this does not appear to be via CYP pathways and is not depicted here. Additional drug-specific views can be selected that display the pharmacokinetic pathways for atorvastatin, lovastatin and simvastatin, fluvastatin, pravastatin and rosuvastatin.

Clicking on the genes will redirect you to information about the gene and its variants, clicking on drugs will take you to the drug information. Externally linked signaling pathways address some of the biologically important effects of statins in the liver and other tissues that result from altered metabolism of intermediates in the cholesterol synthetic pathway.

Authors: Caroline F. Thorn, Lara M. Mangravite, Ronald M. Krauss.
M. Whirl-Carrillo, E.M. McDonagh, J. M. Hebert, L. Gong, K. Sangkuhl, C.F. Thorn, R.B. Altman and T.E. Klein. "Pharmacogenomics Knowledge for Personalized Medicine" Clinical Pharmacology & Therapeutics (2012) 92(4): 414-417. Full text
Therapeutic Categories:
  • Cardiovascular and hematology agents

Entities in the Pathway

Genes (25)

Drugs/Drug Classes (1)

Relationships in the Pathway

Arrow FromArrow ToControllersPMID
AcetylCoA Mevalonate HMGCR 15199031
APOA1, APOA4 HDL PLTP 10079112, 12052475, 14695459
Cholesterol Ester APOA5, APOB, APOC1, APOC2, APOC3, APOE MTTP 10225972, 11588264, 1423598, 15136504, 15864113, 1703299, 2879788, 2932736, 565877, 6308458, 6402711, 6413973, 6897360, 7068630, 7848292, 8044422, 8533758, 8688083
Cholesterol Cholesterol Ester SOAT1 12621162, 15451793
Cholesterol Cholic Acid CYP7A1 10735582, 12093894, 15262185, 15502389, 15707388, 15910869
Cholesterol HDL LCAT 10799014, 11945882, 12023990, 12174215
Free FA Cholesterol Ester
Free FA Phospholipid DGAT1 12123490, 14569040
Free FA Triglycerides DGAT1 10802663, 12031956, 12123490, 12204791, 14569040
HDL Cholesterol SCARB1 12519372, 12568179, 12788901, 12801612, 12807968, 12816880, 15671101, 15694942
HDL IDL 10910363, 12663600, 14563342, 14583798, 14660992, 14984434, 14998629, 15071125, 15655129, 15681846, 15856070, 16002074, 8675707, 9420339
HDL VLDL 10910363, 12663600, 14563342, 14583798, 14660992, 14984434, 14998629, 15071125, 15655129, 15681846, 15856070, 16002074, 8675707, 9420339
HMGCR HMGCR hmg coa reductase inhibitors 10665838, 11349148, 16103896
IDL Cholesterol LRP1
IDL LDL LIPC 11171785, 1158882, 12547874, 15126514, 15156410, 15292318, 16115483, 16338252
LDL Cholesterol LDLR, SCARB1 10736278, 10797611, 10856535, 11071065, 11317192, 11348882, 11500190, 11600564, 12028507, 12059987, 12668918, 15172466, 15530894, 15864114, 15931608, 1940775, 226968, 2390138, 3343347, 7605354, 7830029, 8345800, 8462179, 9105566, 9368827, 9591747, 9645910
Mevalonate Squalene FDFT1 7685352
Squalene Cholesterol SQLE
VLDL IDL LPL 10364086, 10407505, 15127290, 15545743, 8675619, 8873668, 9662394
Cholesterol Cholesterol ABCG5, ABCG8 11099417, 11849674, 14703505, 15175362
Cholesterol Cholesterol ABCB1 10431236, 11349008, 11940086, 15297675, 15474503
Cholesterol Cholesterol ABCB1 10431236, 11349008, 11940086, 15297675, 15474503

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Related Publications

The Clinical Pharmacogenomics Implementation Consortium: CPIC Guideline for SLCO1B1 and Simvastatin-Induced Myopathy. Clinical pharmacology and therapeutics. 2012. Wilke R A, Ramsey L B, Johnson S G, Maxwell W D, McLeod H L, Voora D, Krauss R M, Roden D M, Feng Q, Cooper-Dehoff R M, Gong L, Klein T E, Wadelius M, Niemi M. PubMed
Added value of pharmacogenetic testing in predicting statin response: results from the REGRESS trial. The pharmacogenomics journal. 2012. van der Baan F H, Knol M J, Maitland-van der Zee A H, Regieli J J, van Iperen E P A, Egberts A C G, Klungel O H, Grobbee D E, Jukema J W. PubMed