Abstract
HMG-CoA reductase inhibitors, commonly known as statins, are some of the most widely prescribed medications worldwide and have been shown to be effective at lowering cholesterol in numerous long-term prospective trials, yet there are significant limitations to their use. First, patients receiving statin therapy have relatively low levels of medication adherence compared with other drug classes. Next, numerous statin formulations are available, each with its own unique safety and efficacy profile, and it may be unclear to prescribers which treatment is optimal for their patients. Finally, statins have class-wide side effects of myopathy and rhabdomyolysis that have resulted in a product recall and dosage limitations. Recent evidence suggests that two genomic markers, KIF6 and SLCO1B1, may inform the therapy choice of patients initiating statins. Given the prevalence of statin usage, their potential health advantages and their overall cost to the healthcare system, there could be significant clinical benefit from creating personalized treatment regimens. Ultimately, if this approach is effective it may encourage higher adoption of generic statins when appropriate, promote adherence, lower rates of myopathy, and overall achieve higher value cardiovascular care. This paper will review the evidence for personalized prescribing of statins via KIF6 and SLCO1B1 and consider some of the implications for testing these markers as part of routine clinical care.
Highlights
Coronary heart disease (CHD) is a problem of epidemic proportions that is estimated to be responsible for more than 400,000 deaths annually in the United States (US) [1]
The studies evaluating the utility of Kinesin-like family 6 (KIF6) testing can roughly be broken into two categories: those assessing its utility as a predictive marker of a patient‘s response to statin therapy, and those assessing its utility as a prognostic marker of disease progression
This hypothesis-generating study indicated that patients who were aware of their KIF6 status were approximately twice as likely to be adherent to therapy at 6 months based upon a proportion of days covered (PDC) value greater than 0.80 [46]
Summary
Coronary heart disease (CHD) is a problem of epidemic proportions that is estimated to be responsible for more than 400,000 deaths annually in the United States (US) [1]. Despite evidence that high levels of medication adherence can improve clinical outcomes and quality of life [8,9,10], it has been estimated that up to half of the 3.2 billion prescriptions dispensed annually are not taken as prescribed [11]. Patients do not adhere to their medications for many reasons including low health literacy, cost, inability to feel the drug‘s therapeutic effect, and side effect profiles [13] In response to these barriers, new methods of patient education as well as other strategies such as adjusting the treatment duration, regimen, requirements for lifestyle change, and cost have been employed [11,13,20]. The evidence for utilizing each of these genes to personalize statin treatment is reviewed below
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