Selected Podcast

Ask Dr. Mike: Vap Test for Cholesterol & Clogged Coronary Artery Prevention

Here you'll find the answers to a wealth of health and wellness questions posed by Healthy Talk fans.

Listen in because what you know helps ensure healthy choices you can live with. Today on Healthy Talk, you wanted to know:

I had a Vap test done and I have high levels of lipoprotein(a). Are there some supplements that I can take to help lower these levels?

A Vap test is a measurement of your cholesterol levels. This test gives doctors so much more information as to where your risk for potential disease or conditions really lies. A type of cholesterol, lipoprotein(a), can be a little difficult to bring down. However you might want to consider taking a niacin supplement, omega-3s, and eating walnuts.

I have a 50 percent blockage in the left coronary artery and a 40 percent in my right. My doctor says to just watch and wait, but I would rather be more proactive. Do you have any suggestions on how to prevent this from getting worse?

Your coronary arteries are the two major arteries on both sides of your neck. These arteries are the major blood vessels in your body and are responsible for carrying oxygen, nutrients, and blood to your heart. Once these become clogged with plaque, there's a greater risk for developing heart disease, having a heart attack, or stroke.

Dr. Mike suggests taking vitamin K2 (MK4 & MK7), pine bark extract, and you may also want to consider chelation therapy.

If you have a health question or concern, Dr. Mike encourages you to write him at This email address is being protected from spambots. You need JavaScript enabled to view it. or call in, toll-free, to the LIVE radio show (1.877.711.5211) so he can provide you with support and helpful advice.

RadioMD Presents: Healthy Talk | Original Air Date: February 20, 2015
Host: Dr. Michael Smith

It’s time for you to be a part of the show. Email or call with questions for Dr. Mike now. Email: This email address is being protected from spambots. You need JavaScript enabled to view it. or call: 877-711-5211. What are you waiting for? The doctor is in.

Alright. So, I have my first question here about what is called the VAP test—advanced cholesterol testing and lipoprotein(a). So, here’s the question:

“I had a VAP test done and my lipoprotein(a) was high. Are there supplements that lower lipoprotein(a)?”

Okay. So first, there’s actually a lot to this question. That’s why I wanted to start with it. First of all, what is a VAP test? A VAP test is simply an advanced cholesterol test. You know, I’ve had the authors of the book, The Great Cholesterol Myth, Dr. Stephen Sinatra, who’s one of the leading natural cardiologists in the world, really, and he wrote the book with a nutritionist, Jonny Bowden. I’ve had them both on my show talking about the cholesterol myth. And, you know, one of the things that both of them have said, and I’ve said this before and I agree with them totally, it’s if you just look at total cholesterol or you just look at the bad stuff (LDL) or the good stuff (HDL), by themselves, those are not really the risk factors. You know, cholesterol comes in many different subforms and subtypes. There are different subtypes of LDL cholesterol. There are different subtypes of HDL cholesterol and it’s really those subtypes that give us more information about what your risk is for heart disease from cholesterol. So, the standard cholesterol testing--which is total cholesterol, LDL, HDL and triglycerides--other than the triglycerides, those other three measuring cholesterol don’t really tell us anything. They’re not really helpful in any way and that’s the great cholesterol myth. So, what I have suggested and Dr. Sinatra and Dr. Bowden, also agree, is that what we need to be doing is more advanced cholesterol testing which is available and it’s not that much more expensive. It should be a part of a yearly workup for people. Advanced cholesterol tests, they break down the cholesterol—the good and the bad—into these subtypes and it just gives you so much more information about, you know, where your risk really is.

So, is cholesterol a risk factor for heart disease? Well, by itself, total cholesterol—even LDL, HDL—no, they’re not. It’s the subtypes that we need to look at. It’s the subtypes that bring the risk and one of those subtypes—and you’ll find this only in the advanced testing—is something called lipoprotein(a). Some people call it LP(a), lipoprotein(a), lipoprotein A, it’s all the same thing. It is a very atherogenic compound that sticks out on the surface of the LDL molecule.

Now, LDL stands for low density lipoprotein. It is the carrier molecule for cholesterol and fat from the liver where all that stuff is made and the LDL molecule is the carrier to take all that cholesterol and fat out to your body to your cells and tissues. One of the markers on that carrier molecule called “LDL” is this thing called lipoprotein(a). And, let me tell you, that’s the thing that causes LDL to get sticky and stick in arterial walls and cause atherosclerosis. It’s not the LDL itself, it’s something like the lipoprotein(a) that’s really causing the problem.

So, in this case, this gentlemen had the advanced cholesterol test. I say gentleman. I don’t know why I assumed he was a man. I don’t have that information here. I just did. This listener had the advanced cholesterol test done which is awesome. It included a lipoprotein(a) which is awesome and his was high. Usually, when it’s above 10, you know, that’s when we start getting a little concerned. Above 20, that’s definitely a risk for heart disease. So, I don’t know where the number was for this person, but it was high. So, at least over 10. And he or she wants to know, “What can I do to bring this down?” Well, now, so it’s great to know that. Now, the bad news in all this is, you know, lipoprotein(a) is really hard to bring down. A lot of the traditional supplements that we might use to lower LDL cholesterol, like red yeast rice or, you know, there is Pycnogenol. There are other ones like Policosanol. These are classic. Guggulipids which is a type of soluble fiber. I mean, there are all kinds of different traditional supplements that help to lower LDL completely, but they don’t seem to have a great effect on the lipoprotein(a). There have been some studies that show that Niacin--at high doses, now—about 1500 mg to 2000 mg of Niacin. Now, that’s a lot of Niacin, so if you’re not used to that, don’t start that high because you’re going to flush and you’re not going to be happy with me. So, don’t do that. It might be able to help to bring liproprotein(a) down and, in particular, Niacin mixed with Omega-3 oil. So, Niacin supplement plus an Omega-3 supplement. So, maybe a gram of Niacin plus a gram of Omega-3 has been shown to maybe have some effect on lipoprotein(a). Eating walnuts. I saw a small study where a handful of walnuts a day was helpful. But, here’s the thing: if the lipoprotein(a) was the only thing that was elevated on your VAP, I think you’re fine. I mean, you have to take it into context. I mean, yes, do some things to try to bring it down, maybe. If everything else was okay, maybe just try some walnuts first or something. But, Niacin plus fish oils, plus walnuts would be my best suggestion.

Second question: I think I’m okay here. In keeping with this cardiovascular line of questioning here, “I have a 50% blockage in my left carotid artery and a 40% in my right. My doctor is going to “watch and wait” but I would rather be more proactive. Do you have any suggestions to prevent this from getting worse?”

So, the carotid arteries are in the neck. They go from the heart into your brain, basically, and bring all the good stuff into your brain. It’s the pulse you can feel in your neck. That’s the carotids. Have you ever had a doctor take a stethoscope and place it over your neck and you’re like, “What is he doing? That’s not where my heart is. That’s not where my lungs are.” Well, no. He’s listening for the carotid because if you hear a little wispy sound, that means there could be some blockage there and then, usually, they do an ultrasound to actually identify the blockage. So, in this case, this person had a 50% blockage on one side and 40% on the other, so what can you do? Well, there are some things. Number one, I would probably increase my Vitamin K2 amount. At least a milligram of Vitamin K2. Now, Vitamin K2 is broken up into two major subparts. There’s one called “MK-4” and one called “MK-7”. So, Vitamin K2 is broken up into MK-4 and MK-7. MK-4 is about a milligram a day. MK-7 is about 200 micrograms a day. If I want to get real technical about it, your total Vitamin K2 amount should be about 1.2 milligrams. Okay? One milligram coming from MK-4 and 200 micrograms coming from MK-7. So, that’s the first thing. I would increase Vitamin K2. Vitamin K2 helps to get calcium out of that kind of stuff which could help to decrease the blockage.

You might also consider chelation therapy. Now, you can do the real expensive one with doctors who do that. It’s called “EDTA”. It also removes calcium, plus some other metals, from your body. It can reduce oxidative stress, but it can be expensive, but it’s been shown and there have been a couple of studies recently showing that IV chelation is good for these kinds of blockages. We’re not concluding anything here yet, but it looks very promising. So, maybe chelation therapy. There’s also oral chelation with EDTA that’s available. But now, that’s never been studied. All the studies have been done with IV chelation. So, check that out. And, I do like Pycnogenol—pine bark extract—for this kind of stuff.

So, increase your Vitamin K2, the MK-4 and the MK-7; try some chelation, maybe, with EDTA; and pine bark extract which is better known as Pycnogenol. That might help.

This is Healthy Talk on RadioMD. I’m Dr. Mike. Stay well.