To rephrase the exact same data, 15-year mortality is ~30% higher among those with the normal variant compared to those with the cholesterol-lowering variant. T

To rephrase the exact same data, 15-year mortality is ~30% higher among those with the normal variant compared to those with the cholesterol-lowering variant. That is an enormous mortality effect. Based on the mechanism by which statins are postulated to cause diabetes (and LDLR-dependent mechanism), PCSK9 inhibitors may also cause diabetes, though it's not yet known. From a mortality perspective, this is irrelevant because we know that statins (and PCSK9 mutations) reduce mortality despite (probably) causing diabetes. The timing of statins falling off patent is essentially uncorrelated with anything - there was a multi-year gap with atorvastatin off patent before the PCSK9 inhibitors were approved, which makes no sense if you would like to invoke a patent conspiracy. With the advent of genetically-informed early phase research, you will continue to see new drugs come out at an increasing frequency (reversing the trend over the past few decades of fewer approvals). The link from cholesterol -> CHD -> mortality is as clear as anything in biology (clear enough for the basis for this work to have won a Nobel prize decades ago).