Unmasking the Silent Culprit: Lipoprotein(a) Elevation in a Previously Healthy Individual

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2024-07-01 DOI:10.1016/j.jacl.2024.04.033

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引用次数: 0

Abstract

Background/Synopsis

Lipoprotein A [(Lp(a)] has known atherogenic and thrombotic properties. We present a young patient with recurrent transient ischemic attacks (TIA) and ischemic stroke who was found to have hyperlipidemia and elevated Lp(a) levels. In patients with increased risk of atherosclerosis, screening guidelines recommend checking Lp(a) levels once. This case emphasizes the importance of obtaining Lp(a) levels in young patients with cardiovascular risk factors and appropriate medical therapy.

Objective/Purpose

Describe the importance of Lp (a) screening in young patients.

Methods

Medical record review.

Results

A 49-year-old African American male with a past medical history of anxiety and seizures presented with left sided numbness and paresthesia. Family history was remarkable for diabetes and hypertension. He was diagnosed with a TIA. His LDL-C was 214mg/dL. He was started on atorvastatin 40mg and aspirin 81mg. He continued on this regimen despite uncontrolled LDL-C. Five years later, the patient presented with visual disturbances and headache and was found to have a PCA stroke. A TTE with bubble was negative for PFO and ASD. Holter monitor was unrevealing for arrhythmia. He was started on ezetimibe 10mg and atorvastatin was increased to 80mg. 

One year later, he presented with episodic dizziness. CTA head and neck revealed a basilar TIA.  Laboratory results showed LDL-C 140mg/dL. Lp(a) was obtained as prior workup had been equivocal and was 356.7nmol/L (ref. <75nmol/L). He was started on PCSK9 therapy in addition to his other lipid lowering therapies.

Conclusions

This patient presented with stroke and was found to have an LDL-C above 200mg/dL which should have prompted aggressive medical therapy, lifestyle modifications and close follow-up. He remained on the same medications despite uncontrolled LDL-C. Elevated Lp(a) was discovered only after the patient had suffered multiple events. On average, African American patients have higher Lp(a) levels compared to Caucasian and Asian patients, however this patient's Lp(a) levels are significantly higher than what can be solely attributed to race. It is likely that obtaining Lp(a) during the first event could have changed his clinical course over the years. This case emphasizes the importance of timely Lp(a) screening and prompt intervention.

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揭开无声罪魁祸首的面纱：以前健康的人体内脂蛋白（a）升高

背景/简介脂蛋白 A [(Lp(a)] 具有已知的致动脉粥样硬化和血栓形成特性。我们报告了一名反复出现短暂性脑缺血发作（TIA）和缺血性脑卒中的年轻患者，该患者被发现患有高脂血症且脂蛋白（a）水平升高。对于动脉粥样硬化风险增加的患者，筛查指南建议检查一次脂蛋白（a）水平。本病例强调了在有心血管风险因素的年轻患者中检测脂蛋白（a）水平的重要性，以及适当的药物治疗的重要性。家族有糖尿病和高血压病史。他被诊断为 TIA。他的低密度脂蛋白胆固醇为 214 毫克/分升。他开始服用阿托伐他汀 40 毫克和阿司匹林 81 毫克。尽管低密度脂蛋白胆固醇（LDL-C）未得到控制，但他仍继续服用该药物。五年后，患者出现视力障碍和头痛，被发现患有 PCA 中风。带气泡的 TTE 检查显示 PFO 和 ASD 阴性。Holter 监测仪未显示心律失常。他开始服用依折麦布 10 毫克，阿托伐他汀增至 80 毫克。一年后，他出现阵发性头晕。头颈部CTA显示为基底动脉TIA。实验室结果显示低密度脂蛋白胆固醇为 140 毫克/分升。由于之前的检查结果不明确，因此对脂蛋白（a）进行了检测，结果为 356.7nmol/L（参考值为 75nmol/L）。结论该患者因中风就诊，发现其低密度脂蛋白胆固醇（LDL-C）超过 200 毫克/分升，本应采取积极的药物治疗、生活方式调整和密切随访。尽管低密度脂蛋白胆固醇未得到控制，但他仍在服用相同的药物。直到患者发生多起事件后才发现脂蛋白（a）升高。与白种人和亚洲人相比，非裔美国人患者的脂蛋白（a）水平平均较高，但该患者的脂蛋白（a）水平明显高于种族因素。在第一次事件中获得脂蛋白（a）很可能会改变他多年来的临床病程。本病例强调了及时进行脂蛋白（a）筛查和及时干预的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.