Current global guidelines base statin prevention strategies on 10-year risk, which hinders the prevention of premature disease.

“every major guideline in the world bases their selection of subjects for statin prevention on the 10-year risk of disease and and that was a huge step forward in 1980 and 1990 but but it totally or not totally but it it it very fundamentally makes prevention alma of premature disease almost impossible”

“you go to a framingham risk calculator and you plug in a few variables right i'm this old i do smoke or i don't smoke my hdl cholesterol is this my blood pressure is this what is my 10-year risk and you hit click on the button and a number comes up and most of the guidelines say if that number is below something and a typical response would be if the 10-year risk is below five percent there is no need to treat carry on as normal i'm exaggerating a little bit but that's that's the gist of it”

“i don't use the 10-year risk model”

“you just took a real page out of Alan Snyderman's Jama paper from a few years ago where he really just took aim at this ridiculous notion of tenure risk being remotely helpful in young people”

“this problem with these 10-year risks in younger adults is that yes younger adults are going to have a lower short-term risk over the next 10 years but they have a high you know lifetime risk and that we do them a disservice By ignoring these high values because they haven't crossed some kind of theoretical tenure threshold”

“if I said okay Peter you're my patient you're a healthy guy I calculate your risk is 4.1 percent now what does that number mean is that your risk nope it means that out of a hundred people at 4.1 percent 4.1 of them will have an infarct but we know that within that category there's a tremendous variance in real risk not everybody's at 4.1 some are higher some are lower some are dead on”