PCSK9 and metabolic syndrome: According to the lipid-lowering recommendation of the European Society of Cardiology/European Atherosclerosis Society guidelines 2019 for the management of dyslipidemias and the Italian reimbursement rules of PCSK9-i, all FH subjects started PCSK9-i therapy; in particular, 4 subjects added alirocumab 75 mg, 24 subjects added alirocumab 150 mg, and 28 subjects added evolocumab 140 mg (Fig. 1).