The recently published cholesterol guidelines of the American College of Cardiology and the American Heart Association (ACC–AHA)15 include several changes from the ATP-III guidelines published in 2002. Among these changes is the recommendation that the intensity of therapy be guided by cardiovascular risk rather than by LDL cholesterol goals. However, despite this recommendation, an LDL cholesterol level of less than 70 mg per deciliter remains a treatment target for patients at very high risk for cardiovascular disease in many countries. In our study, this target was achieved in more than 80% of patients with the use of 420 mg of evolocumab every 4 weeks. In addition, there were significant reductions in the levels of other atherogenic, apolipoprotein B–containing lipoproteins, including lipoprotein(a), and modest but significant increases in levels of HDL cholesterol and apolipoprotein A1, similar to those reported with evolocumab previously