Lipoprotein (a) is a variant of LDL particle and has in addition to apolipoprotein B, apolipoprotein (a). It is a strong independent risk factor for premature coronary artery disease. Atherogenicity of Lipoprotein (a) is 10-fold higher than that of LDL cholesterol. It is highly thrombogenic and antifibrinolytic, by virtue of its homology to plasminogen molecule. If HDL is called “good cholesterol”, LDL the “bad cholesterol” and triglyceride the “ugly cholesterol”, Lipoprotein(a) will have to be called the “deadly cholesterol”.
Lipoprotein (a) levels are genetically determined with environmental factors having only a negligible impact. Childhood levels of Lp(a) are a better predictor and marker for future coronary artery disease in young adult life than any other lipoproteins. 15-20 mg/dL is now considered the threshold for development of coronary artery disease.
4-6% reduction in Lipoprotein(a) levels have been reported with treatment using niacin extended release preparations in the dosage range of 1000 to 1500 mg daily.