Some individuals with very highly elevated Lp(a) may appear somewhat immune to its effects, showing no advanced atherosclerosis despite a lack of family history suggesting premature ASCVD and potentially elevated Lp(a) in parents.

“similarly i've had patients whose family histories do not suggest advanced or premature asvd and i told you about one of them earlier 690 nanomole per liter lp little a now this person had a zero calcium score admittedly they were in their 40s so at least say you know a calcium score of zero in your 40s doesn't generally tell you anything but at least tells you that this person isn't having advanced atherosclerosis their family history is very uninspiring and at least one of their parents had to have an elevated level grandparents nothing and i scratch my head and i think why is it that this person seems somewhat immune from their very elevated lp little a whereas this other person who's elevated but not through the roof is ravaged by it”