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Lipoprotein(a) as a unique primary risk factor for early atherosclerotic peripheral arterial disease
  1. John Mayo1,
  2. Thomas Hoffman2,
  3. Ryan Smith3 and
  4. Dwight Kellicut4
  1. 1General Surgery, Tripler Army Medical Center, Honolulu, HI, USA
  2. 2Family Medicine, Tripler Army Medical Center, Honolulu, HI, USA
  3. 3Cardiology, Tripler Army Medical Center, Honolulu, HI, USA
  4. 4Vascular Surgery, Tripler Army Medical Center, Honolulu, HI, USA
  1. Correspondence to Dr John Mayo; john.s.mayo{at}


Elevated plasma lipoprotein(a) is a relatively common condition that contributes to many cardiovascular diseases. However, the awareness and testing for this condition remain low. Herein, we present a case of an otherwise healthy and active man who developed symptoms of peripheral arterial disease starting at age 49, and was found to have hyper-lipoprotein(a) as his only notable risk factor. Diagnosis was not made until years later, after an extensive workup. Upon further screening, he was also found to have subclinical coronary and carotid artery atherosclerotic disease. The patient was treated with aspirin, statin, niacin and angioplasty to bilateral superficial femoral arteries with good symptom resolution. Early screening of his son also revealed a similarly elevated lipoprotein(a) level. It is important to raise awareness of this condition and its relationship to early-onset peripheral arterial disease so patients and their families can be appropriately identified, counselled and treated.

  • vascular surgery
  • general practice / family medicine
  • lipid disorders
  • cardiovascular system
  • cardiovascular medicine

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  • Contributors All authors contributed to this manuscript in a meaningful way. JM wrote the majority and coordinated the entire piece. DK was the vascular surgeon on the case and helped me with the images, captions and manuscript. RS was the cardiologist on the case and helped with the literature and discussion. TH was the primary care physician on the case and helped me with the manuscript and specifically the introduction and discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.