The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
we target an apo b of about 30 to 40 milligrams per deciliter so we target an apob at what we would call a physiologic level so the level that a child would have it's clear that a child can have an apob of 30 and have no problems with development which is the most cholesterol demanding period of their life so there's absolutely no reason that we shouldn't be able to take an adult there without side effects from the medications
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so far at least with pharmacologic lowering of apob with the currently FDA approved drugs there is no signal of harm
although it's clearly something we do in the subset of patients who have significant genetic abnormalities such as the cluster of genetic abnormalities that coalesce around a condition called familial hypercholesterolemia we certainly do medicate those patients usually as teenagers
if you still have options that you can lower it further yeah the trial show yeah there is incremental reduction events but it's a much smaller absolute risk reduction and dropping at the 50 or so
meaning an apob of 30 to 40 milligrams per deciliter which is the level that children would have poses not only no risk to children as evidenced by the fact that I mean that doesn't require an explanation but as evidenced by what we see in the literature on adults with levels that have been pharmacologically reduced tells me that we need to be lower
if I want to talk about APO B that's probably under 50 milligrams per deciliter if we can get there that's what the newborns have that's when you go in clinical trials if you take it down that low you see your most risk reduction
I would view in April OB ceiling of 60 as the limit and that's probably at about the fifth percentile you sort of want everybody to be below the fifth percentile
I've now taken a very different stand which is I've basically taken the stand with others that I've taken with myself which is the evidence is overwhelming that infantile levels of apob are not deleterious in any way meaning an apob of 30 to 40 milligrams per deciliter which is the level that children would have poses not only no risk to children as evidenced by the fact that I mean that doesn't require an explanation but as evidenced by what we see in the literature on adults with levels that have been pharmacologically reduced tells me that we need to be lower
look I think we've got apob B solved right now