Therapy
A 45-year-old with Lp(a) of 180 mg/dL and near-total coronary occlusion improved on intensive medical therapy alone when revascularisation wasn't feasible (Cureus 2025)
Original title: Elevated Lipoprotein(a)-Associated Coronary Artery Disease in a 45-Year-Old Male
This case report describes a 45-year-old man with untreated hypertension, prior ischaemic stroke and significant tobacco use who presented with exertional angina, found to have mildly elevated LDL-C (142 mg/dL), borderline low HDL-C (38 mg/dL), and markedly elevated Lp(a) (180 mg/dL). Coronary angiography revealed chronic total occlusion of the proximal left anterior descending artery, 90% stenosis of the left circumflex artery, and Rentrop grade 3 collateral flow from a codominant right coronary artery; revascularisation was deferred due to financial constraints. Managed instead with high-intensity statins, dual antiplatelet therapy, beta-blockers, ACE inhibitors and lifestyle modification, the patient showed marked symptomatic improvement, better left ventricular ejection fraction, and partial reversal of diastolic dysfunction over follow-up. The authors highlight this case as an example of Lp(a)'s role in premature CAD and demonstrate that intensive medical therapy alone can meaningfully stabilise high-risk patients when revascularisation is not feasible.
Original abstract
Premature coronary artery disease (CAD) in younger adults often arises from underrecognized risk factors such as elevated lipoprotein(a) (Lp(a)), a genetically determined lipoprotein with atherogenic and prothrombotic properties. We report a 45-year-old male with untreated hypertension, prior ischemic stroke, and significant tobacco use, who presented with exertional angina. Laboratory evaluation showed mildly elevated low-density lipoprotein cholesterol (LDL-C; 142 mg/dL), borderline low high-density lipoprotein cholesterol (HDL-C; 38 mg/dL), and markedly elevated Lp(a) (180 mg/dL). Coronary angiography revealed a chronic total occlusion of the proximal left anterior descending (LAD) artery, 90% stenosis of the left circumflex (LCx) artery, and Rentrop grade 3 collateral flow from a codominant right coronary artery. Due to financial constraints, revascularization was deferred. The patient was managed with high-intensity statins, dual antiplatelet therapy, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and lifestyle modification. Over follow-up, he showed marked symptomatic improvement, enhanced left ventricular ejection fraction, and partial reversal of diastolic dysfunction. This case highlights the importance of Lp(a) screening in premature CAD and demonstrates that intensive medical therapy can stabilize high-risk patients when revascularization is not feasible.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.