The panel raised the question of whether there is a possibility of selection bias within the population and whether another population might have observed a different result during the discussion. Continuous reports about various populations in the United States experiencing disproportionate lead contamination were noted. It was suggested that lead level would likely be considered an entry criterion if the study were to be conducted again. It was mentioned that lead levels globally, particularly in developed countries such as the US, Canada, and Western Europe, are generally around <10 on average. However, it was acknowledged that basing assumptions solely on this level might be insufficient, as lead levels in poorer countries are much higher, around 60, while in high-income countries, it is around 14. Reference was made to an article in the Lancet by Larson in 2023, which emphasized the importance of ensuring the presence of the toxin targeted by a treatment within the group being studied. It was noted that although lead levels have decreased over time due to focused public health efforts in the US and Canada, it is essential to consider the toxin's presence when evaluating treatment efficacy. Efforts to determine the next steps with other populations have been initiated, acknowledging the considerable time to complete prior studies that collectively approach a typical human lifespan.

American College of Cardiology (ACC) Congress 2024, 6th April – 8th April 2024, Atlanta, Georgia, USA