The present study was designed to explore and validate the relationship between solute carrier organic anion transporter family member 1B1 (SLCO1B1) and apolipoprotein E (ApoE) gene polymorphisms and both the occurrence of statin-related adverse reactions and the therapeutic efficacy of lipid-lowering treatment in patients receiving statins. To address this aim, we performed a retrospective cohort study involving patients who attended a pharmacist-led outpatient clinic from January 2022 to December 2023. In total, 297 patients met the inclusion criteria and were enrolled in the analysis. Patients were stratified according to their genotypes as well as the type of statin medication administered, and the associations between genetic polymorphisms and the lipid-lowering efficacy of statins were comprehensively evaluated. The analyses revealed that serum TC and LDL-C levels showed statistically significant differences among the ε3, ε4, and overall genotype groups, both before and after adjustment (P < 0.05). Likewise, significant differences in TG levels were observed in the ε2, ε3, and overall genotype groups (P < 0.05). Importantly, post-adjustment values of TC, LDL-C, and TG were consistently and significantly lower than those recorded prior to adjustment. In addition, the incidence of statin-associated musculoskeletal symptoms was found to differ significantly among individuals with the SLCO1B1 c.388 A > G GG genotype, the SLCO1B1 c.521 T > C CT and TT genotypes, as well as in the overall study population before and after adjustment (P < 0.05). Collectively, these findings provided robust evidence that tailoring statin therapy according to ApoE and SLCO1B1 gene polymorphisms could be an effective approach for guiding clinical decision-making. Our study, therefore, offered a valuable reference for clinicians in selecting appropriate statins and in promoting individualized treatment strategies to optimize therapeutic outcomes for diverse patiens populations.
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