**Author details**

buting to disparities in the availability of health services. Most of it can be explained by the prevalence of confounders, such as lack of awareness, in which disproportionate rates seem to rank highly even in developed counties. Given the likelihood of ethnic differences in lipid profiles and the prevalence of hyperlipidemia together with the lack of research in ethnic minorities, it becomes clear that therapy of dyslipidemia remains a major concern worldwide. Being a recognizable risk factor for cardiovascular diseases, it is also questionable whether anti‐lipidemic therapy attains the same effect of cardiovascular risk prevention globally under these conditions. Most importantly, profiling the gene variants in disease and drug response to anti‐lipidemic therapy is the inevitable pathway towards establishing personalized treat‐ ment for this disorder. Pharmacogenetics has slowly found its rightful place in disease management. It is now well acknowledged that polymorphisms in drug‐metabolizing enzymes and transporters of anti‐lipidemic agents contribute to a wide variability in the pharmacokinetic response and toxicity of these drugs. In this regard, ethnicity plays an important role in defining the relevance of the genetic changes in achieving the ultimate goal of personalized drug therapy. However, as demonstrated in the preceding paragraphs, further studies are needed to explore deeper the gene‐dose, gene‐concentration and gene‐response relationships especially for the drug metabolizing CYP450s. The more we make progress in identifying the genetic variations of dyslipidemia or drug response to therapy, the greater the likelihood that personalized medicine becomes a reality rather than remaining a myth in the

Because of the uncertainties summarized above, for the time being targeted drug therapy of hyperlipidemia remains a dream of the future. Nonetheless, profiles of rare variants reflecting on the inter‐individual variability in drug response are becoming more and more evident. Hence, the knowledge we have already acquired of the differential distribution of the impor‐ tant gene variants should provide valuable information in guiding clinicians in determining which gene variants may be relevant in screening patients for personalized therapy in clinical settings in a given society. The validity and usefulness of such an undertaking for routine procedures will depend foremost on the prevalence of such entities. Hence, recommendations

Hypercholesterolemia is a complex disorder which presents in different forms, including the familial form, with varying underlying aetiology, and contributes substantially to CAD manifestation. Predisposing variables for the disease include modifiable risk traits, such as diet, overweight and obesity, that are controllable by adopting healthy eating habits and exercise, for example. However, diet alone is often not adequate to achieve the desired lipid lowering effect in individuals harbouring very high cholesterol levels, such as in familial hypercholesterolemia. This necessitates the use of lipid lowering medication to reduce its production or absorption or other forms of therapy including LDL apheresis or surgery. It is now well established that the response to anti‐lipidemic therapy depends on genetic changes in the disease‐causing as well as ADME‐related genes, and the impact of these gene‐drug

foreseeable future.

158 Cholesterol Lowering Therapies and Drugs

**4. Summary**

for genotype‐adjusted therapy will soon be of time.

Maha M. Alrasheed1 and Nduna Dzimiri2\*

\*Address all correspondence to: dzimiri@kfshrc.edu.sa

1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia

2 King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
