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Looking for some opinions from my fellow NLA members regarding this test.

1. Who uses it and for what patient population?

2. If you do not use it, why not?

Thanks for your assistance,

AnnMarie Swanson, MSN, APNP, CLS

We use it in conjunction with Lp(a) [& if a fibrate is really needed] to "pin-point" the selection of the statin, as a 1st step: Any patient requiring statin therapy. Anyone with elevated Lp(a) we avoid using atorvastatin [especially] and to a lesser degree rosuvastatin. We then try to "stick with" either simvastatin or pravastatin in those folks [both are reliably Lp(a)-"neutral']. In general,.. KIF6 negatives receive low-dose generic,... so if they are Lp(a)-positive they receive simvastatin 10-20 mg [sometimes 40] or pravastatin. Having said that,.. we have nearly every one who is on lipid treatment also on IR or ER niacin: 1-2 grams,.. sometimes up to 3 gms. KIF6 positives receive rosuvstatin mainly,.. but occaisonally we might use atorvastatin. We do NOT use fibrates often,.. but we would lean towards gemfibrozil as the data [EBM] is more "solid" vs. fenofibrate. So,.. they will have fluvastatin as their statin,.. generally. There is a strong "thread" in that whole philosophy to use the most individualized treatment and drive cost down,.. while most aggressively normalizing ALL of their bio-markers. They  are most often measured with a full BHL-Berkeley/Celera  'work-up'. That is all based on good, solid literature/proof-sources. With nearly everyone taking fish oil/krill oil as well as niacin,... the "need" for fibrates are reduced drastically. One of our offices evolved from <8% IR niacin [mainly used ER/Niaspan in 2003],.. to ~40% IR niacin. That really drives down pharmacy cost & patient OOP. Hope something there helps/makes sense to you.

Regards,

SDMc

I would respectfully take issue with a few of the comments from SConnel.

We do not use Kif6 testing at all ! Until any new biomarker  has been shown to ADD to lipoprotein related risk, i believe we should be cautious in its use, from a resource standpoint. although Kif6 testing ADDS to traditional risk factors like lipids, it has NOT been shown to add to lipoprotein determinations like apoB or NMR derived LDL-P. (Since reduction of atherogenic lipoproteins remains our top priority and newer data indicates superiority of NMR derived LDL-P over apoB,  I see no need to use BHL's apoB determination.)

Concerning "With nearly everyone taking fish oil/krill oil as well as niacin,... the "need" for fibrates are reduced drastically", the evidence based medicine database out there clearly supports 2 meds for insulin resistant patients- statins and fibrates. NO signifcant database to support fish oil/krill in these folks. ACCORD LIPID has the best evidence of any combination therapy in reducing residual risk (30% additional risk reduction with high trigs/ low HDL-C group in prespecified analysis  , as we saw in dr elam's talk at SELA). We have no ide what niacin does in insulin resistant patients, so I would rarley use it, unless in a secondary prevention setting. The incredible microvascular reduction effects of fenofibrarte in ACCORD and FIELD also separate it from other potential drugs (omega3's, niacin, ezetimibe)  as a second agent after a statin.

Hope this helps.

Commentary & Rebuttal forthcoming.

SDMc