Background: Elevated lipoprotein(a) [Lp(a)], a subcomponent of LDL cholesterol, has been associated with an increased risk for coronary heart disease. We report a case of a remarkably elevated Lp(a) in a healthy, young male that influenced the clinical care. Case Report:A 44-year old African American male presented with complaints of atypical chest pain of 3 months duration. Lipid profile revealed normal HDL and LDL cholesterols but a triglyceride level of 293. The Lp(a) was 137. Resting EKG was normal. A stress-echocardiogram was abnormal resulting in a coronary angiogram which revealed severe 3-vessel disease. The patient subsequently underwent successful coronary artery bypass graft 2 days later.Conclusions: In the context of minimal traditional cardiovascular risk factors, this case illustrates the potential association between elevated Lp(a) and risk for coronary artery disease. This case also reports the highest published Lp(a) value in the literature which is dramatically higher than the 95th percentile for African American men.

Keywords: Lipoproteins, Coronary Artery Disease, ethnicity, family history