After twisting my doctor's arm to order a VAP test, I've discovered that I have high lipoprotein(a). This is a bad thing, as it is aggressively atherogenic. I'm just beginning to learn about it; so far, the Berkeley Heat Lab's Clinical Reference Manual is the best survey of the literature I've found. I happened across a discussion in a cardiology forum that seems to have a lot of practical information from clinicians who deal with it on a regular basis. They are really sold on Niacin as the best treatment for high lp(a), which was also the conclusion of the Berkeley Lab review. My lp(a) from the VAP test is 28mg/dL, and their target for it is <10. Most of the primary literature made it sound like <30 was OK, but there is a lot of inconsistency in measurement of lp(a), and apparently you need to multiply the VAP numbers by 4 (At least I think that's the conversion factor; I'm still looking into it.) to compare to the literature. Thus my lp(a) is 112... not good. This is the sort of thing you find in people who appear to be in great shape and have good conventional CVD markers, then they drop dead of an MI in their 40's. Lipoprotein (a) is an evolutionary adaptation; it enhances blood clotting when you get slashed by a saber-toothed tiger or the guy in the cave across the street, but is now just a thrombogenic/atherogenic bad actor.
One of the ways to deal with high lp(a) is to be more aggressive with your other CVD risk factors. My total LDL is borderline high (147) by conventional measure and 126 by VAP. My HDL is 81, Trigs are 69, and LDL size profile is the healthy type A. The obvious thing to do here would be to push the LDL down to <100, and I'm considering a low dose statin, in addition to niacin. William Davis at TYP pushes high dose (6g/d) fish oil for treatment of lp(a), along with normalization of hormones with physiological doses of DHEA. My T is on the low side, so that's something to think about, complicated by a bad family history for prostate cancer. As far as lp(a) treatment goes, Davis is an outlier compared to the cardiologists at theheart.org. (the forum linked above) I'm taking 2g fish oil at the moment, and will probably stay there, or maybe go to 3.
What do you guys think about lp(a) and its treatment? Does any know if the VAP factor of 4 is the right way to look at it?