One lipoprotein that may be important in certain people with heart disease is called Lp(a), also known as “lipoprotein little a”. This is a fairly large molecule, but it tends to be easily oxidized (remember that oxidized cholesterol is much more toxic). Furthermore, there is a protein “tail” which can stimulate blood clotting. This lipid-containing molecule is not really very much affected by the types of food that we eat, but appears to be closely related to the genes we inherit from our parents. When it is tested for and found to be elevated, it is not generally affected by treatment with the statin or fibrate drugs. Niacin however can lower the levels by around 35-50%. Vitamin E and other anti-oxidants are generally recommended to try to combat the tendency of Lp(a) to be oxidized. Lowering the LDL to less than 80-100 is also felt to be beneficial in minimizing the toxicity of Lp(a).
Lp(a) is generally not tested for by most physicians