Testing
High Lp(a) drives premature, progressive coronary disease in a young woman despite optimal LDL-C control, case report (JACC Case Rep 2026)
Original title: Premature Coronary Artery Disease in a Young Female Patient With High Lipoprotein(a)
Case report of a 35-year-old African American woman with recurrent chest pain and minimal traditional risk factors, diagnosed with severe multivessel coronary artery disease and found to have markedly elevated Lp(a). Despite percutaneous coronary intervention and optimal LDL-C control with high-intensity statin plus a PCSK9 inhibitor, she developed recurrent angina within 6 months and repeat angiography showed disease progression. The authors highlight high Lp(a) as a driver of premature and progressive coronary artery disease independent of LDL-C, and recommend considering Lp(a) testing in young patients with unexplained or familial coronary disease even when traditional risk factors are minimal.
Original abstract
Background: Premature coronary artery disease (CAD) poses diagnostic challenges, particularly in patients with minimal traditional risk factors. High lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease, and it contributes to early and progressive CAD.
Case Summary: We report the case of a 35-year-old African American woman with recurrent chest pain who was diagnosed with severe multivessel CAD despite minimal traditional cardiovascular risk factors. Further evaluation revealed markedly high Lp(a) levels. She underwent successful percutaneous coronary intervention and achieved optimal low-density lipoprotein cholesterol (LDL-C) control with high-intensity statin therapy and a PCSK9 inhibitor. Despite aggressive lipid-lowering therapy, she developed recurrent angina within 6 months, and repeat coronary angiography demonstrated disease progression.
Discussion: This case highlights the role of high Lp(a) in driving premature and progressive CAD independent of LDL-C levels. Early identification of high Lp(a) may improve risk stratification and inform management strategies.
Take-Home Message: High Lp(a) may contribute to premature and progressive CAD even with optimal LDL-C control, supporting consideration of Lp(a) testing in young patients with unexplained or familial CAD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.