Peter Attia· MD
but he had not had an event that we knew of but for all intents and purposes this is a secondary prevention patient meaning we define secondary as has he had an event or not well he has had an event his event is look at his coronary arteries right but nevertheless he came on 80 milligrams of lipitor and his you know his LDL cholesterol was very low but his particle number was not quite at goal the goal for a patient like that would be tenth percentile or lower given how you're aggressively you're managing he also had a slight elevation of LP little-a so I added zetia which because he had very high levels of absorption not uncommon given how much his cholesterol synthesis was being hit and that brought him into goal so now he was totally at goal his cardiologist was happy I was marginally happy but what I didn't like was his des Master all level was now unmeasurable now it turned out it was unmeasurable before but I was so fixated on just trying to get him in the right zone but now we had some breathing room and I said you know now that I'm thinking about it oh and by the way in the interim Rafa and prowlin had been approved these are pcsk9 inhibitors