Recently, the European Society of Cardiology (ESC) and the European 
Atherosclerosis Society (EAS) published a consensus paper giving guidance on the 
definition and management of statin-associated muscle symptoms (SAMS), as well 
as the use of proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors in 
very high-risk patients. The occurrence of SAMS can have a major negative impact 
on treatment adherence and, consequently, on the prognosis of cardiovascular 
diseases. In addition, both the ESC guidelines on the prevention of 
cardiovascular disease (CVD) in clinical practice with sections addressing 
global strategies to minimise the burden of CVD at population and individual 
levels, and the 2016 ESC/EAS guideline for the management of dyslipidaemias, 
focus on evaluation and treatment of SAMS. The release of these guidelines was a 
source of great interest to clinicians, as new emergent therapies, such as the 
PCSK9 inhibitors, have been approved for the treatment of dyslipidaemias: 
recently, both the US Food and Drugs Administration (FDA) and the European 
Medicines Agency (EMA) approved the use of PCSK9 inhibitors as add-ons for the 
treatment of hypercholesterolaemia in cases where low-density lipoprotein 
cholesterol (LDL-C) target levels could not be reached with maximum tolerated 
statin doses alone, or instead of statins in the event of SAMS. Because of the 
relatively high cost of these new therapies, physicians need to justify the use 
of PCSK9 inhibitors by demonstrating that their high-risk patients' LDL-C levels 
have remained high (1) despite a well-conducted, but insufficiently effective 
high-intensity statin therapy (e.g. rosuvastatin 10-20 mg or atorvastatin 40-80 
mg), or (2) in the event of the patient developing side effects, in particular 
severe SAMS, during treatment with at least three statins. In addition to SAMS, 
the use of PCSK9 inhibitors may be considered in patients with documented 
atherosclerotic cardiovascular disease or in patients with familial 
hypercholesterolaemia and poorly controlled LDL-C under the combination of 
maximum tolerated stain and ezetimibe.