VLDL (very low density lipoprotein) is a type of lipid protein in the blood that contains the highest amount of triglycerides. LDL, or low density lipoprotein, contains the highest amount of cholesterol. VLDL is considered one of the “bad” cholesterols but is difficult to measure, and not done so routinely. Reducing the amount of triglycerides in the blood will reduce the VLDL. Lp(a) is another blood lipoprotein that contains an apo(a) component and, when the concentration is very high, has been associated with an increased incidence of stroke and heart disease.

The Women’s Health Study recently showed that hormone use reduced the concentration of Lp(a). Currently, there are no guidelines recommending intervention based on high Lp(a) levels despite findings from some studies suggesting that lowering Lp(a) might be beneficial. But I don’t think doctors are blasé about it. They simply use other values such as LDL, HDL, and total cholesterol. I also don’t think physicians fuss about small deviations in LDL or sodium levels. I rarely measure LDL more than once a year in a patient unless I have changed their statin dose or drug, and rarely measure sodium unless the patient has renal disease, blood pressure problems, or an endocrine abnormality.

Managing Blood Lipid Levels The Saturday Evening Post