The European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines recommend consideration of PCSK9i in individuals with familial hypercholesterolemia and high Lp(a) (class IIa) [21], while the Canadian Cardiovascular Society (CCS) guidelines recommend consideration of PCSK9i for secondary prevention in individuals with Lp(a) ≥60 mg/dL [22]. This evidence concerns the gene LPA and metabolic syndrome.