Management of heterozygous FH is aimed at primary prevention of atherosclerotic cardiovascular disease through lipid lowering pharmacological therapy, using statins, ezetimibe or PCSK9 inhibitors or other LDL lowering medications, with guidelines recommending initiation at ages 8–10 or earlier based on severity (Carroll et al., 2008; Gidding et al., 2015; Defesche et al., 2017; Kim et al., 2021). Here, PCSK9 is linked to familial hyperaldosteronism.