Adverse drug reactions (ADRs) represent an important cause of morbidity and
mortality worldwide. Statins are a class of drugs whose main adverse effects are drug-induced
liver injury (DILI) and myopathy. Some of these may be predictable, due to their pharmacokinetic
and pharmacodynamic properties, while others, unfortunately, are idiosyncratic.
Genetic factors may also influence patient susceptibility to DILI and myopathy in the case of
statins. This review will first discuss the role of statins in cardiovascular disease treatment and
prevention and the underlying mechanisms of action. Furthermore, to explore the susceptibility
of statin-induced adverse events such as myopathy and hepatotoxicity, it will then focus on
the recent Genome-Wide Association Studies (GWAS) concerning the transporter genes, Cytochrome
P450 (CYP), organic anion-transporting polypeptide (OATP) and ABCB1 and
ABCC1, which seem to play a role in the development of clinically relevant adverse events.
Finally, we appraise the evidence for and against the use of statins in metabolic syndrome and
in HCV-infected patients, in terms of their safety and efficacy in cardiovascular events.