Mitunter zeigen Personen ohne relevante Risikofaktoren eine fortgeschrittene Atherosklerose auf – welche natürlich nur mit Bildgebung erfasst werden kann (in erster Linie Ultraschall der Halsschlagader, in zweiter Linie Ca-Score der Herzkranzgefässe). Es lohnt sich deshalb bei diesen Personen nach weiteren Risikofaktoren zu suchen, insbesondere erhöhte Werte für Lipoprotein a (LPa), Blutzucker, Entzündung (C-reaktives Protein) oder Homozystein.
Sometimes people without relevant risk factors show advanced atherosclerosis – which of course can only be detected with imaging (primarily ultrasound of the carotid artery, secondarily Ca-score of the coronary arteries). It is therefore worth looking for other risk factors in these people, in particular elevated levels of lipoprotein a (LPa), blood sugar, inflammation (C-reactive protein) or homocysteine.
Case Report
History and findings: This female patient presented to Kardiolab to Kardiolab in 2016 at age 53 with LDL 4.4 and cTPA of 57 mm2. Despite statin therapy and LDL of 1.8 in 2024, cTPA had increased to 79 mm2 and CAC score was 137 (see image). We then measured LP(a) and Homozystein, which were both elevated to 889 and 30 respectively.
Management: Consequently, Atorvastatin was increased to 40 mg/d, and Ezetimibe was maintained at 10 mg/d, Folic Acid 2.5 mg/d was added.
Imaging: Coronary plain CT Scan showing a LAD calcification (in red)
Conclusion
Despite good control of LDL, blood pressure, no diabetes, no smoking, this 60 year old patient had a significant increase in carotid plaque amounts, that was not explained by these traditional cardiovascular risk factors. The search for additional risk factors revealed a very high amount of LP(a) and Homocysteine as a possible cause for the increase in cTPA. Statin dose was increased and daily 100 mg Aspirin was added because of increased atherothrombosis risk.
Additional Information
