Q: After I finally understood what was meant by "good" and "bad" cholesterol in the blood, my doctor came up with a new one when she told me my lipoprotein(a) is too high. I would like to know more about this lipoprotein.
A: Let me begin with a brief refresher course. There is, in fact, no "good" or "bad" cholesterol; all the cholesterol in the blood can be considered bad. Instead, there are good and bad protein carriers (lipoproteins) of the cholesterol and other fats in the blood. The main carrier of cholesterol is low density lipoprotein (LDL), and LDL is a "bad" lipoprotein because it deposits cholesterol in arteries and initiates the process of atherosclerosis. High density lipoprotein (HDL) is a "good" lipoprotein because it can remove cholesterol from the arterial wall and thus protect against atherosclerosis. Still controversial is whether to consider very low density lipoprotein (VLDL), which carries most of the triglycerides in the blood, consistently "bad." High levels of VLDL are clearly a risk for heart disease in women and diabetics, but not necessarily in men.