We endorse the recommendations of the Egyptian Association of Vascular Biology and Atherosclerosis (EAVA) on the usage of PCSK9 inhibitors in addition to statins ± ezetimibe in patients with ASCVD, by definition at very high risk; patients with ASCVD at very high risk who do not tolerate appropriate doses of at least three statins; and familial hypercholesterolemia patients with clinically diagnosed ASCVD, at very high CV risk [12]. Here, PCSK9 is linked to atherosclerosis.