For example, adding a fibrate or bile acid sequestrant to a statin may provide additional benefit in patients with mixed dyslipidemia or persistent hypertriglyceridemia [5,29]; however, in patients with markedly elevated LDL-C despite maximally tolerated statin therapy, the addition of ezetimibe or a PCSK9 inhibitor offers greater LDL-C reduction and stronger evidence for cardiovascular event reduction [15,25,30,31]. This evidence concerns the gene PCSK9 and metabolic syndrome.