Hidden Heart Risk: Lp(a), BAC, and CAC Findings Without Symptoms

Full analysis

A woman in her 50s with a strong family history of early heart disease — father and both grandfathers died of heart attacks in their 60s — describes discovering three clinical risk markers she had no symptoms for: elevated Lipoprotein(a), or Lp(a), a genetically determined form of bad cholesterol not linked to lifestyle; breast arterial calcifications (BACs) spotted on a routine mammogram, which can signal arterial plaque; and a poor coronary artery calcium (CAC) score, a CT-based measure of calcified plaque in heart arteries. None of these showed up as symptoms — her cardiologist's questions about her exercise habits suggested she felt fine.

The practical takeaway is twofold. First, a high CAC score can qualify a patient for insurance coverage of Repatha, a biweekly injectable medication (generic name evolocumab) used to lower Lp(a) and LDL cholesterol and stabilize or partially reverse arterial plaque — coverage that can otherwise be difficult to obtain. Second, the author's cardiologist identified the mammogram BAC finding as a prompt to request Lp(a) testing, a CAC scan, and a cardiology referral — a sequence that readers with similar family histories may want to discuss with their own doctors.