PCSK9 and familial hyperaldosteronism: Therefore, given that carriers of LDLR or PCSK9 rare variants continue to be exposed to genetic effects after birth and accumulate the risk of MI, we propose that we should check LDLR and PCSK9 rare variants in patients with juvenile-onset hyper-LDL cholesterolaemia, whether a diagnosis of FH is made, and that a preemptive therapy for normalizing LDL cholesterol levels should be undertaken to prevent MI as long as patients have LDLR rare variants or PCSK9 gain-of-function variants.