Lipoprotein (a)

Case Studies

• Case Studies

  August 2023

  Take this short quiz to test your knowledge on the recently published debate on dyslipidemias titled “Great debate: lipid-lowering therapies should be guided by vascular imaging rather than by circulating biomarkers”.

  CLICK HERE TO VIEW THE DEBATE.

  Eur Heart J. 2023 Jul 1;44(25):2292-2304. doi: 10.1093/eurheartj/ehad275

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• Case Studies

  Quiz of the month – February 2023

  Take our patient case study quiz specially curated for you by our Faculty Member, Prof. Stephen Nicholls.

  Case Study: A 58-year-old overweight man with a 10-year history of primary hypercholesterolemia presents for a checkup. At diagnosis of hypercholesterolemia, his LDL-C was 198 mg/dL; his clinician recommended diet and exercise interventions and started atorvastatin 10 mg qd. The patient follows a low saturated-fat diet and exercises daily. However, he could not tolerate higher doses of atorvastatin or rosuvastatin 5 mg or pravastatin 20 mg. Today, his LDL-C is 138 mg/dL, HDL-C 52 mg/dL, and triglycerides 78 mg/dL. He continues to take atorvastatin 10 mg qd.

  You add ezetimibe, and follow-up bloods a month later show an LDL-C of 108 mg/dl. You are not sure if he has ASCVD, so review of prior imaging shows he had a CT scan a year ago to evaluate shortness of breath, and the report comments that he has “moderate coronary artery calcification”. You check and Lp(a) and it is elevated at 200 nmol/L (upper limit of normal is 75 nmol/L).

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• Which of the following might be appropriate at this time?

  a) Change statin to pitavastatin

  b) Add PCSK9 inhibitor (either mAb or inclisiran)

  c) Add bile acid sequestrant

  d) Add icosapent ethyl

  None
  

  Time's up

• Case Studies

  Quiz of the month – November 2022

  Take our patient case study quiz specially curated for you by our Faculty Member, Prof. Chern-En Chiang.

  Case Study: A 48 y male patient presented with anterior chest pain for 1 hour. He was sent to ER where acute anterior ST-elevation MI was diagnosed. Emergent cardiac catheterization demonstrated a 30-40% stenosis over left main artery, a 100% occlusion over middle portion of left anterior descending artery, 90% stenosis over middle portion of right coronary artery, and a 50% stenosis in the proximal portion of left circumflex artery. Two DES were implanted uneventful: one on LAD and the other on RCA. Echocardiogram revealed an LVEF 52% with mild hypokinesis over LV anterior wall.

   

  Past history:	Type 2 diabetes for 5 years with metformin 1000 mg/d Hypercholesterolemia under rosuvastatin 10 mg/d Denied history of HT No smoking history
  Family history:	Strong family history of premature CVD (His father died of MI at the age of 58. His grandfather died of MI at the age of 65, and his uncle has TVD.)
  Before discharge:	BMI 25 BP 128/76 mmHg, HR 76/min eGFR 76 ml/min, Na 141 meq/L, K 4.1 meq/L HbA1c 7.1% LDL-C 124 mg/dL, HDL-C 42 mg/dL, triglyceride 210 mg/dL, Lp(a) 105 mg/dL
  Discharge medications:	Aspirin 100 mg QD, ticagrelor 90 mg BD, bisoprolol 5 mg QD, metformin 850 mg BD, dapagliflozin 10 mg QD, rosuvastatin 20 mg QD, ezetimibe 10 mg QD
  3-month follow-up clinic:	No symptom BMI 24 BP 120/72 mmHg, HR 66/min eGFR 72 ml/min, Na 144 meq/L, K 4.2 meq/L HbA1c 6.4 % LDL-C 77 mg/dL, HDL-C 48 mg/dL, triglyceride 198 mg/dL, Lp(a) 108 mg/dL

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• What are your next steps? (multiple choice)

  a) Discontinue aspirin

  b) Add a GLP1 RA

  c) Add a PCSK9 inhibitor

  d) Add inclisiran (not available in most of the Asian countries)

  e) Add fenofibrate

  f) Add fish oil

  g) Check Lp(a) in his blood relatives

  h) Others not mentioned here
  

  Time's up