Brief Answer: please see details Detailed Answer: Hi Thanks for posting your query on XXXXXXX 1. Indeed the lipoprotein (a) levels are higher than the prescribed range, however this factor has not established itself as an independent risk factor for coronary artery disease, beyond the estimation of standard lipid profile (as per ATP III guidelines on cholesterol control which are as yet the last ATP guidelines on issue ). The index case also has a favorable lipid profile with LDL cholesterol of 76 mg% and HDL cholesterol of 62 mg% and VLDL cholesterol of 14 mg%. Hence no treatment is warranted. 2. Some researchers stresses that if a patient has one risk factor for anginal heart disease or has high familial risk of premature anginal heart disease, LP (a) can be used as a another marker to lower LDL cholesterol but in given case LDL is already well controlled, hence no action is warranted. However I would like to know if the patient has diabetes?/ high blood pressure?/ exposure to Smoking?/ family history of anginal heart disease (age of relative at onset)/ or patient has history of any other cardiovascular disease? This will help me in elaborating further on issue. Sincerely Sukhvinder

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Brief Answer: please see below Detailed Answer: Dear Sir/ Madam As I discussed previously that LP (a) was touted as one of the strong risk factors for future anginal heart disease by some studies. However other studies failed to show the risk beyond the usual lipid profile. Then our governing bodies (mainly american college of cardiology) through its documents and associated guidelines, refused to accept it as independent marker. Moreover in certain circumstances (as told in last answer) it may be used for risk assessment, but in given case, that too does not apply. Moreover the beneficial effects of lowering this entity are also not known. As per the current lipid profile no intervention is required. Neither any intervention is warranted for her raised LP (a) as the guidelines do not recognize it to be a risk factor independent of LDL levels. However she should continue a healthy life style including daily brisk walk (under prescription), low fat diet, optimal weight (body mass index ~23), avoiding sweets and fried items and relaxation exercise. These will help her in keeping a good cardiovascular health. Sincerely Sukhvinder

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