Testing
Case report: a veteran athlete with a QRISK3 score of 4.1% turns out to have 75% coronary stenosis driven by elevated Lp(a) (Front Cardiovasc Med 2025)
Original title: Case Report: Elevated Lp(a) as a cause of severe ASCVD in a healthy veteran athlete with low calculated QRISK3 score
This case report describes an asymptomatic, normotensive, non-smoking veteran athlete in his late 40s with moderately raised LDL-C and a calculated 10-year QRISK3 score of just 4.1%, a level that would not typically prompt further cardiovascular investigation. Because his Lp(a) was significantly elevated, he underwent advanced cardiovascular imaging, which revealed severe stenosis (75%, CAD-RADS 4A) of the left anterior descending coronary artery. The authors use the case to illustrate that widely used clinical risk tools such as QRISK3, which omit Lp(a), can substantially underestimate cardiovascular risk in individuals with elevated Lp(a), reinforcing the case for routine Lp(a) measurement even in apparently low-risk patients.
Original 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.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.