Your Health Alert
Week 8
Tuesday, December 9th, 2008
Daily Camera, Boulder, CO
Genetics Testing in Preventive Medicine
Have you had your gene tests for Apo E and KIF6? Most people don’t know why these genes are so important, but they can actually help you create an individualized prevention and treatment plan that is based on your genetics. Individualized is the key word. I do not have any two patients with the same risk factors, and so I cannot abide by a “one drug, one diet fits all” mentality. I test my patients for these genes so that I can prescribe a treatment plan that fits their genetics and will be the most successful.
The first gene I test for is the Apolipoprotein E (Apo E). It plays an important role in lipoprotein metabolism, and there are different isoforms of Apo E based upon the person’s Apo E genotype. Everyone on earth is one of three Apo E genotypes, and they each have different variations on lipid metabolism. Because of these differences, we give the following advice:
11% of the population is Apo E 2, and they should:
- Eat a diet more liberal in the consumption of the good fats (mono and polyunsaturated) like the Mediterranean diet with up to 35% of the calories as fats.
- Eat no refined carbohydrates.
- Exercise is maximally beneficial.
- One or two drinks of alcohol a day is good, unless there are medical or religious reasons not to.
64% of the population is Apo E 3. Apo E 3:
- Has normal lipid metabolism and thus no genotype impact.
25 % of people are Apo E 4. Apo E 4 patients:
- Must be on a very low fat diet with less than 15% of calories from the good fats.
- They should not drink alcohol.
- They are at a 40% increased risk for a heart attack or stroke.
- Should have all risk factors treated more aggressively.
Also note that Apo E 2 patients respond better to the statin drugs while those who are Apo E 4 respond better to the drug Zetia.
I also test patients for the KIF6719Arg (KIF6) gene variant. 60% of the population is a KIF6 carrier and has up to a 55% greater risk of a coronary event compared to non-carriers. This risk is independent of traditional risk factors such as lipid levels, age, sex, diabetes, smoking, family history and hypertension. Studies show that if one needs to be treated with a statin it should be with a high dose in a KIF6 carrier. In non-carriers the high dose of a statin conferred no additional benefit.
Remember that atherosclerosis is a multifactoral disease, and not everyone has it for the same reasons. It is important that to get an individualized treatment plan that is made specifically for you.
Joe Turnbow, M.D.
Copyright 2008, Heart Attack Prevention Strategies P.C. All rights reserved.