This recommendation is made based on the fact that: 1) no dedicated primary prevention trials involving PCSK9 mAbs (evolocumab, alirocumab) have been performed; and 2) one meta-analysis identified 21% to 27% risk reduction (95% CI: 6%-42%) in stroke for PCSK9 mAbs when compared to placebo but did not specify whether individuals had prevalent stroke at baseline, thereby making recommendations for primary prevention of stroke unclear.29 This evidence concerns the gene PCSK9 and Stroke.