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Screening for Lipoprotein(a) Levels in Persons at Low Risk for Cardiovascular DiseaseA Teachable Moment

Educational Objective: To describe the value of screening for lipoprotein(a) levels and the effect of treatment.
1 Credit CME

A 64-year-old woman with a history of breast cancer and paroxysmal atrial fibrillation was referred by her primary care physician to our cardiology clinic for cardiac risk assessment. She had no cardiovascular risk factors or family history of cardiovascular disease (CVD) and reported having a healthy diet and regular exercise.

The patient’s primary care physician had ordered lipid profile testing, the results of which were total cholesterol, 224 mg/dL; high-density lipoprotein cholesterol, 107 mg/dL; low-density lipoprotein cholesterol, 97 mg/dL (to convert all cholesterol results to mmol/L, multiply by 0.0259); triglycerides, 96 mg/dL (to convert to mmol/L, multiply by 0.0113); and lipoprotein(a) (Lp[a]), 110 mg/dL (to convert to mg/L, multiply by 0.1). The physician advised starting treatment with a statin and referred her to a cardiologist.

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Article Information

Corresponding Author: Ludovico Furlan, MD, IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy (ludovico.furlan@unimi.it).

Published Online: January 19, 2021. doi:10.1001/jamainternmed.2020.8367

Conflict of Interest Disclosures: None reported.

Disclaimer: Dr Redberg is Editor of JAMA Internal Medicine, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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2.
Anderson  TJ , Grégoire  J , Pearson  GJ ,  et al.  2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult.   Can J Cardiol. 2016;32(11):1263-1282. doi:10.1016/j.cjca.2016.07.510PubMedGoogle ScholarCrossref
3.
Grundy  SM , Stone  NJ , Bailey  AL ,  et al.  2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.   J Am Coll Cardiol. 2019;73(24):e285-e350. doi:10.1016/j.jacc.2018.11.003PubMedGoogle ScholarCrossref
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US Department of Veterans Affairs, US Department of Defense. VA/DoD clinical practice guideline for the management of dyslipidemia for cardiovascular risk reduction. June 2020. Accessed October 21, 2020. https://www.healthquality.va.gov/guidelines/CD/lipids/VADoDDyslipidemiaCPG5087212020.pdf
5.
Cook  NR , Mora  S , Ridker  PM .  Lipoprotein(a) and cardiovascular risk prediction among women.   J Am Coll Cardiol. 2018;72(3):287-296. doi:10.1016/j.jacc.2018.04.060PubMedGoogle ScholarCrossref
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