It was observed that decreased LDLR level by PCSK9 in macrophages influences on the reduced number of foam cell development inside the artery wall and causing decreased atherosclerosis manifestation.58,76 Hence, it could be said that PCSK9 secreted through macrophages released into the plasma and the atheroma, becomes gathered in the lesion that affects the composition of plaque regardless of the amount of serum lipid. This evidence concerns the gene LDLR and atherosclerosis.