And there's no ambiguity . LDL is causally related LDL cholesterol or a ob causally related to atherosclerosis . Well , if that's true and I haven't seen a credible argument that it's not , there are people who argue that it's not by the way , but they just don't have credibility in their arguments , then you have to say that what we're doing in medicine today is very backwards because what we're doing in medicine today is the following .
So , Mendelian randomization is such an elegant tool where you basically let genes do the randomization . And as you said , there is a gradation of LDL concentration or a OB concentration that occurs from insanely low to insanely high . And this is a wildly polygenic polymorphic set of conditions .
So it's sort of like , uh you know , just doesn't work . So the i the implication there is if you're uh and if your mace risk is less than 5% the thinking is you do not need to treat LDL or a OB I argue that that makes absolutely no sense . It's just as idiotic as the analogy I used around smoking .
So , and we have calculators that are pretty good at predicting your 10 year event risk . They'll look at your cholesterol levels , your blood pressure , they'll ask if you smoke , they'll ask some family history questions and they'll spit out a number . Now , we should do yours after the fact .
So , you know , there's gonna be somebody listening to this who says my , my grandmother is 95 years old . She's as her cholesterol is sky high and she's alive and well , and I will say absolutely . There are a lot of people walking around that way , just as there are a lot of smokers walking around who don't get lung cancer .
