Ischemic stroke in a young adult with extremely elevated lipoprotein(a): A case report and review of literature |
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| Affiliation: | 1. UAB School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;2. Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, Children''s of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA;3. Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL, USA;1. Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich;2. Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, Mich;3. Department of Pathology, University of Michigan, Ann Arbor, Mich;4. Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham, and Women''s Hospital, Harvard Medical School, Boston, Mass;1. Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA;2. Lancaster General Health/Penn Medicine, Lancaster, PA, USA;3. Department of Medicine, Duke Clinical Research Institute, Durham, NC, USA;4. The FH Foundation, South Pasadena, CA, USA;5. Department of Medicine, New York University School of Medicine, New York, NY, USA;6. Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA;7. Preventive Cardiology Inc., Boca Raton, FL, USA;8. Cardiology Division, Massachusetts General Hospital, Boston, MA, USA;9. The Rogosin Institute, New York, NY, USA;10. Mayo Clinic, Rochester, MN, USA;11. Department of Pediatrics, Nemours Cardiac Center, Wilmington, DE, USA;12. Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA;13. Department of Pediatrics, West Virginia University, Morgantown, WV, USA;14. Department of Medicine, Baylor College of Medicine, Houston, TX, USA;15. Vanderbilt University School of Medicine, Nashville, TN, USA;p. Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA;q. University of Kansas Medical Center, Kansas City, KS, USA;r. Department of Medicine, Stanford University, Stanford, CA, USA |
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| Abstract: | Lipoprotein(a) [Lp(a)] is an apolipoprotein(a) molecule bound to 1 apolipoprotein B-100. Elevated levels of Lp(a) are thought to be an independent risk factor for atherosclerosis and to promote thrombosis through incompletely understood mechanisms. We report a 34-year-old man with an ischemic stroke in the setting of an extremely high Lp(a) level—212 mg/dL. He developed severe carotid artery stenosis over a 6-year period and had thrombus formation post-carotid endarterectomy. To our knowledge, this case is unique because the Lp(a) is the highest reported level in a patient without renal disease. Moreover, this is the first reported case of the youngest individual with a stroke presumably related to development of carotid plaque over a 6-year period. The thrombotic complication after endarterectomy may have been related to the prothrombotic properties of Lp(a). Of note, the Lp(a) level did not respond to atorvastatin but did decrease 15% after aspirin 325 mg was added although his Lp(a) levels were variable, and it is not clear that this was cause and effect. This case highlights the need to better understand the relation between Lp(a) and vascular disease and the need to screen family members for elevated Lp(a). We also review treatment options to lower Lp(a) and ongoing clinical trials of newer lipid-lowering drugs that can also lower Lp(a). |
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| Keywords: | Lipoprotein(a) Atherosclerosis Carotid stenosis Thrombosis |
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