Guiliana Mombelli, Samuela Castelnuovo, Chiara PavanelloCardiovascular Department, Dyslipidemia Center, Azienda Ospedaliera Niguarda Cà Granda, Milan, ItalyAbstract: A large proportion of patients at high risk for cardiovascular disease continue to suffer from cardiovascular events despite current therapies. The need for additional therapies to lower the residual risk has led to research on new pharmacological approaches. The discovery of proteins regulating the activity of the low-density lipoprotein receptor has been a major breakthrough in the development of new cholesterol-lowering drugs. This review describes inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) as a promising treatment for familial hypercholesterolemia, especially the relatively good short-term safety of PCSK9 inhibitors. In particular, we focus on its additive effect with statins and its advantage as a monotherapy in statin-intolerant patients. The additional low-density lipoprotein cholesterol lowering obtained with PCSK9 inhibition will be able to reduce the additional risk, but its effect on cardiovascular events has to be evaluated in future studies.Keywords: proprotein convertase subtilisin/kexin type 9, PCSK9, additional or replacement therapy to statins, statin intolerance, residual cardiovascular risk