However, their use is limited: the European guidelines recommend PCSK9 inhibitors for patients with persistently high LDLc levels (despite treatment with the maximum tolerated dose of statins in combination with ezetimibe) – class I – or for patients with statin intolerance (class IIB), as well as in the setting of familial hypercholesterolemia with very high cardiovascular risk (class IC) [6]. This evidence concerns the gene PCSK9 and familial hypercholesterolemia.