CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
This article is part of the Research TopicCase Reports in Coronary Artery Disease: 2025View all 20 articles
Where do blood lipids remain? Extreme hypertriglyceridaemia and multivessel coronary artery disease: a case report
Provisionally accepted
- 1Department of Residency, Riga Stradins University, Riga, Latvia
- 2Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia
- 3Faculty of Medicine and Life Sciences, University of Latvia, Riga, Latvia
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Background Elevated triglycerides have been established as a cardiovascular risk marker and the literature suggests an association with lipid-rich plaques. We report a case of severe hypertriglyceridaemia that did not result in lipid-rich atherosclerotic lesions. Case summary Coronary angiography of a 54-year-old man with a triglyceride level >113.00 mmol/Ll revealed severe multivessel disease. Near-infrared spectroscopy (NIRS) demonstrated a low plaque lipid content, including the maximum lipid-core burden index within 4 mm of 0 in the right coronary artery (RCA), with >90% stenosis in the middle segment. To achieve a rapid reduction in the triglyceride level, intravenous administration of insulin and heparin combined with subsequent plasmapheresis was used, and a triglyceride level of 5.79 mmol/Ll was achieved before discharge. Genetic testing confirmed familial hypertriglyceridaemia with a pathogenic variant in the lipoprotein lipase gene. Conclusions In a patient with severely elevated serum triglycerides and premature three-artery disease, low plaque lipid content was established with the NIRS investigation. Pharmacological management of very severe hypertriglyceridaemia with intravenous insulin and heparin therapy can rapidly decrease triglyceride levels.
Keywords: case report, severe hypertriglyceridaemia, Premature atherosclerosis, multivesseldisease, Intravascular imaging, near-infrared spectroscopy, Plasmapheresis
Received: 04 May 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Kokina, Trusinskis, Lapsovs, Roze and Erglis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Baiba Kokina, baiba.kokina@gmail.com
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