Randomized clinical trials typically run over shorter periods and enroll high-risk individuals, providing insufficient data for treatment recommendations in lower-risk, younger populations.

“randomized clinical trials are expensive and so you run them over a you know generally a short time period you know five years and you want to enroll high-risk people that are going to have events over the next five years you really can't feasibly do a randomized clinical trial for decades and decades and so by Nature these lower risk individuals and younger adults are not included in these trials and then it comes down to the fact that we don't have data specifically for treatment in this population”