Twenty-two years ago, the landmark 4S trial demonstrated that statin therapy could reduce rates of recurrent myocardial infarction, stroke, and cardiovascular death among secondary prevention patients with overt hyperlipidaemia.1 Since that time, large-scale statin trials have shown that an exceptionally wide range of patients benefit from statins, including those without evidence of underlying vascular disease or hyperlipidaemia. Yet many statin-treated patients continue to suffer from life-threatening vascular events, an issue commonly described in the clinical literature as the problem of ‘residual risk’.

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One side of the residual risk coin undoubtedly relates to further reduction in low-density lipoprotein cholesterol (LDLC). Ever more aggressive cholesterol reduction is the cornerstone for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that dramatically lower LDLC among those on statins, among those with statin intolerance,...

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