PCSK9 and Abnormal emotional state: Our nationwide cohort study demonstrates significantly lower adherence and persistence to PCSK9 mAbs and oral LLD compared with findings in the landmark lipid trials.4,5 The explanation may be less close monitoring in daily clinical practice and a more heterogenic patient population with lower risk perception, higher level of psychological distress, lack of memory, and more self-perceived side effects, all known barriers for adherence to LLDs.29 The poor adherence to oral lipid lowering therapies is particularly worrisome, as an opportunity of additive LDL-C effect is missed.