Lipoprotein (a) (Lp(a)) excess is an independent risk factor of coronary artery disease (CAD) and have shown wide ethnic variations.Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl). Many studies have pointed out that Lp(a) levels may be a risk factor for cardiovascular diseases (Bandara, 2016). Female sex, family history of CAD, high concentrations of total cholesterol (TC) and low density lipoproteins(LDL) were reported to be associated with high concentration of Lp(a) (Bandara, 2016). We present a 21-year-old female who presented to a tertiary care hospital with typical features of a non ST elevated myocardial infarction (NSTEMI) as a result of a thrombus in left main coronary artery (LMCA) and confirmed witha marginally high low density lipoprotein (LDL) and lipoprotein (a) with a borderline high risk for CAD. All other causes for CAD was excluded. She gives a family history of CAD in her paternal uncle and cousin who died at the age of 28 years after a major coronary infarction. She is currently managed with lipid lowering drugs and dual antiplatelet drugs (DAPT)
