The FOURIER trial showed a benefit in reducing cardiovascular events when LDL was lowered to the 30s mg/dL range, even in patients on maximally dosed statins.

“especially fourier because you'll recall fourier the patients had an average starting ldl cholesterol in the 70s i can't remember if it was 71 or 77. i think the mean was 90 and they brought it back down to 30 milligrams was the mean 90 i thought the mean at the beginning was in the 70s but i could be wrong there was not an entry level of ldl sometimes you see that in these kinds of trials you have to bring the ldl down to a certain level uh but that was not the case so it was they were just being treated with uh standard of care which is obvious yeah so these were all very high doses of statins so if you're right and they were if they came in on a statin maximally and their ldl was 90 that's still very low that still puts them at the 10th percentile i thought it was 70 so that would have been at the 5th percentile but the point is when patients come in and they already have such a low ldl you add a drug that lowers them to the 30s but the trial was only five years and my thought was there's no way in five years you ha that's not long enough to see a benefit when the patients are starting out so low and that turned out to be wrong so the trial support was supposed to last five it was four point four she saw a benefit at 2.2 years old wait that's right it was 2.2 and four years exactly”