Left Main Heart Stent at Age 34: The Importance of Lipoprotein(a)

In medical school nearly 40 years ago I was taught that heart disease is mainly due to smoking, hypertension, diabetes, cholesterol disorders, and a family history of early heart events (Framingham risk factors). Most patients are still evaluated by obtaining information regarding these 5 factors. Missing from this approach are major advances in understanding the development of coronary artery disease (CAD). One of the most important advances is the recognition that a type of lipid (cholesterol) particle that is inherited on a genetic basis is both common and causes a large number of tragic cardiac events, even deaths. This particle is called Lipoprotein(a) or Lp(a) and can be easily measured in a blood sample at most laboratories. A recent case at the Kahn Center for Cardiac Longevity was striking for the role of Lp(a) in causing early and severe CAD.

Case Study

In 2009, a 34-year old man with no known cardiac disease began training for a half-marathon running event. He had no known heart disease, never smoked, was on no medications, and did not have a history of premature CAD. He developed jaw pain while training and scheduled a medical evaluation leading to a stress test. Due to abnormalities found on the treadmill test, he had a coronary angiogram showing a severe narrowing in his left main…