In many patients it is difficult to achieve the current very low target LDL-cholesterol levels, recommended for the prevention of atherosclerotic cardiovascular events. If statin therapy or statins in combination with ezetimibe are not sufficient, addition of PCSK9 inhibitors should be considered. PCSK9 inhibitors reduce LDL-CH by an average of 50-60 % and reduce the risk of atherosclerotic cardiovascular events. They are currently reserved for patients with atherosclerotic cardiovascular disease and for patients with familial hypercholesterolaemia, in whom despite intensive hypolipidemic therapy statins with ezetimibe the target LDL-cholesterol value is not reached. In these patients, PCSK9 inhibitors may also be indicated in case of statin intolerance.