Given the low proportion of US adults recommended for add-on lipid-lowering therapy by the 2018 AHA/ACC cholesterol guideline who are taking ezetimibe or a PCSK9 inhibitor in 2013-March 2020, interventions are likely needed to increase guideline-recommended add-on lipid-lowering therapy among adults with very-high risk for recurrent ASCVD events. This evidence concerns the gene PCSK9 and atherosclerosis.