A phase III, randomized, multicenter, double-blind, two-armed, parallel, active-controlled, non-inferiority clinical trial to compare efficacy and safety of Evolocumab (CinnaGen) versus Evolocumab (Repatha®, Amgen Inc.) in patients with hyperlipidemia receiving concurrent high intensity statin

Inclusion criteria:

Male or female ≥18 to ≤75 years of age Willingness for signing and having signed the informed consent form Should have received an approved high intensity statin at a stable daily dose, at least 4 weeks before screening, and has not achieved the target LDL-C level Having Established Atherosclerotic Cardiovascular Disease (ASCVD) (secondary prevention) or patients without established ASCVD (primary prevention) who are categorized as “very high risk” in ASCVD risk assessment according to AACE/ACE 2020 guideline ASCVD is defined as diagnosis of myocardial infarction, diagnosis of non-hemorrhagic stroke (TIA does not qualify as stroke for inclusion), symptomatic peripheral arterial disease (PAD), as evidenced by intermittent claudication with ankle-brachial index (ABI) greater than 0.85, or peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease.- ”Very high risk” in ASCVD risk assessment is defined as followed:• Diabetes with at least 1 risk factor(s)• CKD greater than or equal to 3 with albuminuria (assessed by urine albumin/urine creatinine ratio) • HeFH Fasting LDL-C as determined by the central laboratory at screening equal or greater than 70 milligram per deciliter Fasting triglycerides less than or equal to 400 milligram per deciliter

Exclusion criteria:

New York Heart Association (NYHA) III or IV heart failure or LVEF less than 30% Uncontrolled hypertension (SBP more than 180 mmHg or DBP>110 mm Hg) Type 1 diabetes, newly diagnosed or poorly controlled type 2 diabetes (HbA1c more than 8.5%) Active pancreatitis Uncontrolled serious cardiac arrhythmia less or equal to 3 months prior to randomization History of myocardial infarction/unstable angina, PCI (percutaneous coronary intervention), CABG, or stroke less or equal 3 months prior to randomization Have inadequate organ and marrow function as indicated by laboratory values:• TSH less than LLN or TSH more than1.5×ULN (in addition to abnormal free T4)• eGFR<30 mL/min/1.73m2• AST or ALT more than 3×ULN• CK more than 5×ULN Active infection Hepatitis C infection History of deep vein thrombosis or pulmonary embolism less or equal 3 months prior to randomization Administration of bile acid-sequestering resins, statins (outside of study regimen), ezetimibe, fibrates, less than 200 mg/day niacin, or more than 1000 milligram/day omega-3 fatty acids less or equal to 6 weeks prior to randomization Administration of cyclosporine, systemic steroids, vitamin A derivatives and retinol derivatives for the treatment of dermatologic conditions (except for the purpose of supplementation) less than 3 months prior to randomization Prohibited procedures such as cardiac surgery or revascularization, any weight loss procedure (e.g., bariatric surgery) within 3 months prior to randomization, or receiving any major organ transplant (e.g., lung, liver, heart, bone marrow and renal), LDL or plasma apheresis within 12 months prior to randomization Personal or family history of hereditary muscular disorders Major hematologic, metabolic, or GI disruption A female subject who is pregnant or breast feeding, or planning to become pregnant while enrolled in the study Previously received Evolocumab or any other investigational therapy to inhibit PCSK9 On a dietary regimen which is significantly deviated from recommended diet by physician (e.g., high levels of carbohydrates or lipids, low fiber regimens, or regular alcohol consumption) Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject’s participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.

Target sample size: 250