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Heart Attack in a Healthy 34-Year Old With Elevated Lipoprotein(a) Cholesterol
Everyone has heard about LDL cholesterol, elevated blood pressure, diabetes mellitus and smoking in terms of heart disease risk. Unfortunately, most have not heard of Lipoprotein(a), also known as Lp(a) or the “sticky” cholesterol. Lp(a) is a low-density lipoprotein (LDL) cholesterol particle with an added tail called apolipoprotein(a) that makes it a unique and potentially dangerous for future heart attack, stroke, and valvular disease. An individual’s Lp(a) level is 80–90% genetically determined in an autosomal codominant inheritance pattern with full expression by 1–2 years of age and adult-like levels achieved by approximately 5 years of age. The Lp(a) level remains stable through an individual’s lifetime regardless of lifestyle. Approximately 1 out of every 4 person inherits the gene for Lp(a) and manifests an elevated level in the blood lifelong. Although most health care practitioners are not yet routinely ordering a simple blood test to assess the presence and level of Lp(a) in their practice, my preventive cardiology clinic is a referral center for those with Lp(a) and I see many patients. This case study of a healthy 34 year old emphasizes the need to widen our testing, and improving our therapy, for Lp(a) elevations.
