**8. Conclusion**

PCSK9i have emerged as a breakthrough antihyperlipidemic therapy in the current era, where ASCVD is the leading cause for morbidity and mortality. PCSK9i are efficacious and safe. Current literature on their suboptimal use in real-world settings indicates that a large proportion of these patients could benefit from more aggressive treatment with this class of lipid lowering therapy. The cost-effectiveness of PCSK9i can be improved by restricting its use in patients with increased risk of ASCVD, who derived more benefit in the PCSK9i outcome trials. Also, the most recent AHA/ACC multi-society guidelines on the management of hyperlipidemia gave a class 1 recommendation to adding ezetimibe to maximally tolerated statin therapy for secondary prevention prior to initiation of PCSK9 inhibitors. This would also help triage PCSK9i use in people who are highest risk which in turn would improve its cost effectiveness.
