Monitoring desmosterol may be important to avoid excessive inhibition of cholesterol synthesis in the brain for patients prone to dementia requiring a statin.

“so if I were giving you massive doses of your favorite korilla statin per guidelines and I simply measured serum des must roll on your next visit and it was low that tells me I've over I've stopped the synthesis of cholesterol too much”

“now to which I say the following one I am sympathetic to what you are saying because I realize that all of the anti statin rhetoric out there is so illogical and they throw everything in the sink right like but you know oh my god it causes you know diabetes does it well yeah and a small small subset of the population we're gonna see a slight uptick in the risk of diabetes especially with atorvastatin does that mean statins cause diabetes and it needs to be avoided as a result of that no does it you know do a subset of patients end up getting you know muscular pain of course it's probably five to ten percent it might be even a bit higher depending on the nature of the trial but what I think is really going on here this is this is my hypothesis Alzheimer's disease as you said a second ago is multiple diseases it is not a disease right but even if you talk about Alzheimer's disease even if there is a final common pathway or a set of pathognomonic features that define the disease I think there are several ways to get there there is a metabolic way that people get there that is probably explained by the increase incidence we see in cognitive impairment and and Alzheimer's disease in patients with diabetes and insulin resistance but there's also a vascular component that I don't think gets nearly enough attention”

“we look at two markers of cholesterol synthesis does master all and lithosterol we monitor them very closely and there is a small body of literature that says at least in high-risk people maybe people who carry one or two copies of an apoe4 gene that very low levels of dysmostral and or lithosterol in the presence of statins may be a predictor of increased risk”

“if desol was dropping low and we'd use an arbitrary cut off point the 20th percentile would that be maybe you don't want to inhibit cholesterol synthesis in the brain to that degree”

“we would watch desm rol incredibly closely in that population”

“right now if you want you could measure dmol and perhaps use that as a cautionary marker number one if they're not on a drug and it's low you if you haven't done an apoe4 genotype you might look at it”

“we would watch desol incredibly closely in that population so now the last thing I'll tell you if the asite is not making cholesterol because of it's being overs supressed by a Statin the neuron would be getting less cholesterol the neuron would convert none of that cholesterol to 24s hydroxy cholesterol cuz it's trying to conserve every cholesterol molecule it can”