Abstract
A 61-year-old man presented with central chest and vague left shoulder pain precipitated by a brisk walk up a steep hill. His pain resolved with rest. He has never had this pain before and had no associated symptoms. He has no other medical problems. He is known to have three vessel coronary artery disease (CAD) based on two previous cardiac catheterizations.
Highlights
An otherwise healthy 61-year-old male presented with stable angina without traditional risk factors for coronary artery atherosclerosis
The lipid core is the same as low-density lipoprotein (LDL), and the protein component consists of apoB-100 and apoA
90% of an Lp(a) level is determined by the allele of the apoA gene [6]
Summary
An otherwise healthy 61-year-old male presented with stable angina without traditional risk factors for coronary artery atherosclerosis. Lack of traditional risk factors was the impetus for a more extensive workup, including specific lipoproteins, including Lp(a). Lp(a) is a low density lipoprotein that has a lipid core and a protein component. The lipid core is the same as LDL, and the protein component consists of apoB-100 and apoA. The apoA in the protein component of Lp(a) is similar to plasminogen. Both have the kringle K-IV and K-V and protease domains of plasminogen. Other genetic factors including lipoprotein metabolism can affect Lp(a) levels [3]. 90% of an Lp(a) level is determined by the allele of the apoA gene [6]. The genetic determination for Lp(a) level has been demonstrated in the study of twins [7,8]
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