Peter Attia· MD
if you're persistently elevated we've gone so far as to like look with biopsies Etc and in very rare circumstances is there actual liver injury that's happening with some of these drugs and I can count on one hand how many times we've seen demonstrable liver injury that we think is associated with um one of these lipid lowering agents the the real summary point is that there's so many Alternatives that often times that we that don't induce um or cause elevations um that are well tolerated and have a either more potent um lipid lowering effect or better tolerated by that person so it depends on degree of ele a within the bounds of what we expect is sort of the upper limit of normal or is there some evidence of liver injury going on and is there an alternative yeah I mean we we tend to be very aggressive on this Julia we we don't really tend to like to tolerate elevations of the As and ALT and as you said we obviously today have far more Tools in our toolkit to um to get people off those drugs if if that's what's happening