For a patient with known CAD and low baseline HDL, would a PCSK9 inhibitor be a better option than a statin, given concerns for paradoxical lowering of HDL levels with statin therapy that we can encounter in the outpatient clinical setting?   

Statin therapy would still be your first choice as we know that they reduce CVD related outcomes regardless of the HDL. In fact, studies show that patients with low HDL benefit even more from statin therapy.

With 35-40 years of statin successes, a PCSK9 should only be used without a statin when a patient cannot tolerate a statin. My definition of the latter would be the usual complaints WITH a significant, several-fold increase in CK. The 99.9% of patients with statin-associated muscle/skeletal pains, e...

Long-term studies support statin therapy first. Add PCSK9 if needed to further lower LDL.

I agree with sticking to a statin. In fact, statins usually result in a modest increase in HDL.

Agree with statin as first line.