Elevated plasma levels of both small dense LDL (sdLDL) and the LDL cholesterol regulator, proprotein convertase subtilisin/kexin 9 (PCSK9) were observed in diabetic patients with poor glycemic control, insulin resistance and lower levels of HDL, indicating the role for PCSK9 in dyslipidemia and atherosclerosis [29,30]. Here, PCSK9 is linked to metabolic syndrome.