Statins are the first-line treatment for
familial hypercholesterolemia (FH), but response is highly variable due to genetic and nongenetic factors. Here, we explored the association between response and genetic variability in 114 Brazilian adult FH patients. Specifically, a panel of 84 genes was analyzed by exon-targeted gene sequencing (ETGS), and the functional impact of variants in pharmacokinetic (PK) genes was assessed using an array of functionality prediction methods.
Low-density lipoprotein cholesterol (
LDL-c) response to
statins (reduction ≥ 50%) and
statin-related adverse event (SRAE) risk were assessed in carriers of deleterious variants in PK-related genes using multivariate linear regression analyses. Fifty-eight (50.8%) FH patients responded to
statins, and 24 (21.0%) had SRAE. Results of the multivariate regression analysis revealed that ABCC1 rs45511401 significantly increased
LDL-c reduction after
statin treatment (p < 0.05). In silico analysis of the
amino-acid change using molecular docking showed that ABCC1 rs45511401 possibly impairs
statin efflux. Deleterious variants in PK genes were not associated with an increased risk of SRAE. In conclusion, the deleterious variant ABCC1 rs45511401 enhanced
LDL-c response in Brazilian FH patients. As such, this variant might be a promising candidate for the individualization of
statin therapy.