Management of Elevated Lipoprotein(a) Levels | Patient Case Quiz

A 52-year-old male, with no known cardiovascular risk factors, has a history of a non–ST-elevation myocardial infarction (NSTEMI) one year ago. His lipid levels prior to that event were: total cholesterol 200 mg/dL, high-density lipoprotein cholesterol (HDL-C) 45 mg/dL, triglycerides 140 mg/dL, and low-density lipoprotein cholesterol (LDL-C) 127 mg/dL. He has been taking atorvastatin 80 mg/day and aspirin 81 mg/day since that event.

He presents to the emergency department with evidence of another NSTEMI. His blood pressure is 118/70 mm Hg, and his body mass index (BMI) is 26. He has no smoking history and no known glucose intolerance. He has no family history of premature coronary heart disease (CHD), but he has no siblings and his father died of cancer at age 54. His current lipid levels on atorvastatin are: cholesterol 140 mg/dL, HDL-C 45 mg/dL, triglycerides 150 mg/dL, and LDL-C 65 mg/dL. Specialized lipid tests were obtained, showing apoliprotein B (ApoB) 95 mg/dL, LDL-P (by NMR) 1,180, and lipoprotein(a) (Lp[a]) 102 mg/dL (total particle mass measurement). Cardiac catheterization showed diffuse three-vessel disease.

Which of the following statements describes your recommendation for further lipid therapy?

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