# Case Report: Elevated Lp(a) as a cause of severe ASCVD in a healthy veteran athlete with low calculated QRISK3 score

## TL;DR

A healthy veteran athlete with a low risk score was found to have severe heart disease due to high Lp(a) levels, showing the need to measure Lp(a) for better risk assessment.

## Contribution

Highlights the clinical importance of measuring Lp(a) despite low risk scores from standard tools.

## Key findings

- A veteran athlete with a low QRISK3 score had severe coronary artery stenosis due to elevated Lp(a).
- Standard risk tools underestimated the patient's cardiovascular risk, emphasizing the need for Lp(a) testing.

## Abstract

Elevated plasma lipoprotein(a) [Lp(a)] is a causal risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). However, commonly used ASCVD clinical risk-assessment tools in primary care do not include the measurement of Lp(a) levels, potentially under-estimating individual risk. Here we describe the case of a late-40s, asymptomatic, normotensive, non-smoking veteran athlete with a moderately raised low density lipoprotein cholesterol (LDL-C) level and a calculated 10-year QRISK3 score of 4.1%. Despite his low calculated QRISK3 score, significantly elevated Lp(a) levels led to advanced cardiovascular imaging, which revealed severe stenosis (75%, CAD-RADS 4A) of the left anterior descending coronary artery. This case demonstrates the limitations of conventional cardiovascular risk tools and highlights the importance of Lp(a) measurement for identifying and managing high-risk patients.