Chest Pain and Hidden Genetic Risk: A Case Report on the Role of Elevated Lipoprotein(a) in Early Cardiovascular Disease

TL;DR

A case report highlights how elevated lipoprotein(a) contributes to early cardiovascular disease and the need for targeted treatments.

Contribution

The case emphasizes the importance of measuring Lp(a) and using emerging therapies for high-risk patients.

Findings

A 53-year-old woman with elevated Lp(a) levels developed coronary artery disease despite statin therapy.

PCSK9 inhibitors and nucleic acid-based treatments like Zerlasiran show promise in lowering Lp(a).

European guidelines recommend routine Lp(a) testing for better cardiovascular risk assessment.

Abstract

Lipoprotein(a) (Lp(a)) is increasingly recognized as a significant contributor to the risk of atherosclerotic cardiovascular disease (ASCVD). We report the case of a 53-year-old woman who presented with chest pain and has notable family history of premature cardiovascular events. Investigation revealed a markedly elevated Lp(a) level of 492 nmol/L, alongside the presence of coronary artery disease necessitating stenting.

Despite adherence to high-intensity statin therapy, her low-density lipoprotein (LDL) cholesterol levels remained suboptimal. Consequently, we initiated treatment with a PCSK9 inhibitor to achieve further reductions in LDL cholesterol. This case underscores the importance of routinely measuring Lp(a), as recommended by European guidelines, which advocate for its assessment at least once during adulthood for effective risk stratification.

While lifestyle interventions play a critical role in cardiovascular health, targeted therapies such as PCSK9 inhibitors and emerging nucleic acid-based treatments, including Zerlasiran, offer promising options for significantly lowering Lp(a) levels. Recognizing and addressing elevated Lp(a) is vital for identifying patients at high cardiovascular risk and for informing tailored management strategies aimed at improving patient outcomes.

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