While statins remain the cornerstone of primary prevention due to their affordability and robust evidence base, PCSK9 inhibitors may serve as a valuable adjunct for selected patients, particularly those with familial hypercholesterolemia, type 2 diabetes, or elevated lipoprotein(a), who are unable to achieve guideline-recommended lipid targets or are statin-intolerant. The gene discussed is PCSK9; the disease is familial hypercholesterolemia.