Abeer Fatima, Wani Aasim A, Ahraz Ali
Internal Medicine, Government Medical College, Srinagar, IND.
Chemical Engineering, National Institute of Technology, Srinagar, IND.
Cureus. 2025 Apr 4;17(4):e81684. doi: 10.7759/cureus.81684. eCollection 2025 Apr.
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.
年轻成年人的早发性冠状动脉疾病（CAD）通常源于未被充分认识的危险因素，如脂蛋白(a) [Lp(a)]升高，Lp(a)是一种具有致动脉粥样硬化和促血栓形成特性的遗传性脂蛋白。我们报告了一名45岁男性，患有未经治疗的高血压、既往缺血性中风且大量吸烟，因劳力性心绞痛就诊。实验室检查显示低密度脂蛋白胆固醇（LDL-C）轻度升高（142mg/dL），高密度脂蛋白胆固醇（HDL-C）临界低值（38mg/dL），Lp(a)显著升高（180mg/dL）。冠状动脉造影显示左前降支（LAD）近端慢性完全闭塞，左旋支（LCx）动脉90%狭窄，优势右冠状动脉的Rentrop 3级侧支血流。由于经济限制，血运重建被推迟。患者接受高强度他汀类药物、双联抗血小板治疗、β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂治疗及生活方式改变。在随访期间，他的症状明显改善，左心室射血分数提高，舒张功能障碍部分逆转。该病例强调了Lp(a)筛查在早发性CAD中的重要性，并表明当血运重建不可行时，强化药物治疗可使高危患者病情稳定。
