Cognitive Function in a Randomized Trial of Evolocumab

To the Editor: In the article regarding cognitive function in patients receiving the proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitor evolocumab, Giugliano et al. (Aug. 17 issue)¹ report that evolocumab does not affect neurocognition, even in patients who attained very low levels of low-density lipoprotein (LDL) cholesterol. In the EBBINGHAUS trial (Evaluating PCSK9 Binding Antibody Influence on Cognitive Health in High Cardiovascular Risk Subjects), Giugliano et al. prospectively assessed cognitive function across a wide range of domains, including memory and attention. However, no test was performed to evaluate depressive symptoms specifically. Depression negatively affects performance on cognitive tests and may . . .