According to the lipid lowering recommendation of 2019 European Society of Cardiology/European Atherosclerosis Society guidelines for the management of dyslipidemias and the Italian reimbursement rules of PCSK9-i, all FH patients added PCSK9-i; in particular, 3 patients started alirocumab 75 mg, 12 patients started alirocumab 150 mg, and 15 patients started evolocumab 140 mg (Figure 1). The gene discussed is PCSK9; the disease is metabolic syndrome.