Although the follow-up time of existing trials does not exceed 3 years, a meta-analysis did not find aggressive LDL lowering by PCSK9-inhibitors increases ICH risk, even in high-risk patients with previous ischaemic or haemorrhagic stroke, indicating that LDL might not be the sole driver.17 Because of the widespread lipidomic effect of the genetic score we used, it is not possible from our current analyses to make inferences about which particle class is the causal mediator of this association. This evidence concerns the gene PCSK9 and hemorrhagic stroke.