{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T02:11:47Z","timestamp":1758334307383,"version":"3.44.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>While advances in technology and procedural techniques have significantly improved outcomes post-PCI, two pharmacological strategies have gained particular attention for their effectiveness in reducing long-term cardiovascular (CV) risk: anti-platelet therapies and lipid-lowering therapies (LLT). The 10-year recurrence risk for major CV events remains as high as 10\u201330%, due to various pathophysiological pathways collectively known as residual risk (RR), even with optimal CV risk factor management after acute coronary syndrome (ACS). RR includes factors such as elevated lipoprotein(a) [Lp(a)], triglycerides, pro-thrombotic states, hyperglycemia, and persistent subclinical arterial inflammation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This case highlights the challenge of managing a patient with multiple recurrent cardiac ischaemic events and in-stent restenosis, despite good medical therapy and no other significant CV risk factors except for markedly elevated Lp(a) levels.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Three critical aspects of daily practice emerge from our observation. First, Lp(a) is a valuable parameter for CV risk stratification in primary prevention. Second, measurement of Lp(a) post-CV event may provide valuable information on the risk of ischaemic recurrence, influencing decisions regarding long-term dual anti-platelet therapy (DAPT). Finally, this case illustrates the importance of a multidisciplinary approach in managing patients with very high cardiovascular risk. Close collaboration between cardiologists and lipidologists facilitated the identification of a rare lipid disorder and the decision to pursue lipoprotein apheresis, an intensive but effective treatment option for lipid metabolism disorders lacking conventional medical therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf389","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T21:59:06Z","timestamp":1755035946000},"source":"Crossref","is-referenced-by-count":0,"title":["The challenge of secondary cardiovascular prevention in very high Lipoprotein (a) level: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7421-0014","authenticated-orcid":false,"given":"Andrea","family":"D\u2019Amuri","sequence":"first","affiliation":[{"name":"Medical Department, General Medicine Unit, Azienda Ospedaliera Carlo Poma, ASST Mantova , Str. Lago Paiolo 10, Mantova 46100 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0318-8966","authenticated-orcid":false,"given":"Pietro","family":"Di Gangi","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic-Vascular Department, Cardiology Unit, Azienda Ospedaliera Carlo Poma, ASST Mantova , Str. Lago Paiolo 10, Mantova 46100 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Pagani","sequence":"additional","affiliation":[{"name":"Medical Department, General Medicine Unit, Azienda Ospedaliera Carlo Poma, ASST Mantova , Str. Lago Paiolo 10, Mantova 46100 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corrado","family":"Lettieri","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic-Vascular Department, Cardiology Unit, Azienda Ospedaliera Carlo Poma, ASST Mantova , Str. Lago Paiolo 10, Mantova 46100 ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"2025091917323287500_ytaf389-B1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2025091917323287500_ytaf389-B2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk","volume":"41","author":"Mach","year":"2020","journal-title":"Eur Heart J"},{"key":"2025091917323287500_ytaf389-B3","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1161\/CIRCULATIONAHA.116.021314","article-title":"Distribution of estimated 10-year risk of recurrent vascular events and residual risk in a secondary prevention population","volume":"134","author":"Kaasenbrood","year":"2016","journal-title":"Circulation"},{"key":"2025091917323287500_ytaf389-B4","doi-asserted-by":"crossref","first-page":"3925","DOI":"10.1093\/eurheartj\/ehac361","article-title":"Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement","volume":"43","author":"Kronenberg","year":"2022","journal-title":"Eur Heart J"},{"key":"2025091917323287500_ytaf389-B5","first-page":"429","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies with the special contribution of the European Association of Preventive Cardiology (EAPC)","volume":"75","author":"Visseren","year":"2022","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"2025091917323287500_ytaf389-B6","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1093\/eurjpc\/zwae276","article-title":"Lipoprotein(a): don\u2019t forget about secondary prevention","volume":"31","author":"Bhatia","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"2025091917323287500_ytaf389-B7","doi-asserted-by":"crossref","first-page":"e023578","DOI":"10.1161\/JAHA.121.023578","article-title":"How do lipoprotein(a) concentrations affect clinical outcomes for patients with stable coronary artery disease who underwent different dual antiplatelet therapy after percutaneous coronary intervention?","volume":"11","author":"Cui","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2025091917323287500_ytaf389-B8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.5603\/cj.93062","article-title":"Prolonged dual antiplatelet therapy in invasively treated acute coronary syndrome patients with different lipoprotein(a) concentrations","volume":"31","author":"Cui","year":"2024","journal-title":"Cardiol J"},{"key":"2025091917323287500_ytaf389-B9","doi-asserted-by":"crossref","first-page":"100675","DOI":"10.1016\/j.jacadv.2023.100675","article-title":"Lipoprotein(a) and benefit of antiplatelet therapy: insights from the PEGASUS-TIMI 54 trial","volume":"2","author":"Patel","year":"2023","journal-title":"JACC Adv"},{"key":"2025091917323287500_ytaf389-B10","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/j.jacc.2023.02.033","article-title":"Clinical trial design for lipoprotein(a)-lowering therapies: JACC focus seminar 2\/3","volume":"81","author":"Malick","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2025091917323287500_ytaf389-B11","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.2174\/1381612829666230412105238","article-title":"PCSK9 inhibition in atherosclerotic cardiovascular disease","volume":"29","author":"Delialis","year":"2023","journal-title":"Curr Pharm Des"},{"key":"2025091917323287500_ytaf389-B12","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.jacl.2019.09.010","article-title":"Lipoprotein apheresis for lipoprotein(a) and cardiovascular disease","volume":"13","author":"Moriarty","year":"2019","journal-title":"J Clin Lipidol"},{"year":"2009","key":"2025091917323287500_ytaf389-B13"},{"key":"2025091917323287500_ytaf389-B14","doi-asserted-by":"crossref","first-page":"100624","DOI":"10.1016\/j.lanepe.2023.100624","article-title":"Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study","volume":"29","author":"Ray","year":"2023","journal-title":"Lancet Reg Health Eur"},{"key":"2025091917323287500_ytaf389-B15","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1001\/jamacardio.2018.1470","article-title":"Association of LPA variants with risk of coronary disease and the implications for lipoprotein(a)-lowering therapies: a mendelian randomization analysis","volume":"3","author":"Burgess","year":"2018","journal-title":"JAMA Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf389\/63994364\/ytaf389.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/9\/ytaf389\/63994364\/ytaf389.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/9\/ytaf389\/63994364\/ytaf389.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T21:32:41Z","timestamp":1758317561000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf389\/8229062"}},"subtitle":[],"editor":[{"given":"Silvia","family":"Cavarretta","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Stefania Angela","family":"Di Fusco","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Yusuf Ziya","family":"Sener","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,9]]},"references-count":15,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf389","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,8,9]]},"article-number":"ytaf389"}}