PCSK9 inhibitors may change thinking about treating children with FH, though pre-clinical data on PCSK9's role in brain development and Alzheimer's risk is considered insufficient by some.

“and by the way John has the thinking changed with pcsk9 Inhibitors because I guess you could make the argument well statins are impairing cholesterol synthesis and maybe in a developing child that could be problematic but a pcsk9 inhibitor has no bearing on cholesterol synthesis it's simply amplifying LDL clearance so does that change the thinking at all well it changed my thinking and I agree with you but there are other indications all pre-clinical so pretty useless in my opinion that in the embryonic stage pcsk9 has a role in brain development and there are some mendelian randomization studies that pick up an increased signal for Alzheimer's disease with low pcsk9 while all the trials actually have never shown any effect on cognition”