Recently, it has been reported that patients with highest PCSK9 concentrations had the highest CAC score.24 Plasma PCSK9 concentrations were also independently associated with the severity of coronary artery stenosis and even major adverse cardiovascular events in stable CAD patients.25,26 Statins decrease hepatic intracellular cholesterol, resulting in increased PCSK9 protein, as well as increased LDLR.27 It is possible that PCSK9 inhibitors canceled the action of PCSK9 increased by statin treatment, resulting in the prevention of calcification. This evidence concerns the gene LDLR and coronary stenosis.