By identifying potentially trans associations with PCSK9 levels, our data give rise to the possibility of a more complex mechanism, where different genetic factors may modulate PCSK9. It remains to be determined if PCSK9 levels driven by trans genetic factors carry the same increased risk of cardiovascular disease as PCSK9 levels determined by genetic variation at the PCSK9 locus. The gene discussed is PCSK9; the disease is cardiovascular disorder.