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Low HDL Cholesterol (Hypoalphalipoproteinemia) Follow-up

  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: George T Griffing, MD  more...
Updated: Jun 19, 2013

Further Outpatient Care

See the list below:

  • Provide outpatient care at regular intervals, especially clinical evaluation, lipid profile assessment, and follow-up evaluations for complications (such as coronary heart disease).
  • Monitor patients frequently to ascertain the effectiveness of medical treatment and to determine whether complications are arising from drug therapy. For example, monitor liver function tests and eye function when treating patients with lipid-lowering agents.

Further Inpatient Care

See the list below:

  • Generally, patients with hypoalphalipoproteinemia (HA) are discovered during routine lipid profile testing. Such patients are ambulatory and do not usually require hospitalization or inpatient care.
  • Inpatient care is usually required for complications arising from accelerated atherosclerosis.
  • In patients with secondary causes of HA, inpatient care may become necessary based on the primary pathology.

Inpatient & Outpatient Medications

See the list below:

  • Niacin or nicotinic acid
  • Gemfibrozil (Lopid) or fenofibrate (Tricor)
  • Statins
    • Atorvastatin (Lipitor)
    • Simvastatin (Zocor)
    • Pravastatin (Pravachol)


See the list below:

  • Patients with hypoalphalipoproteinemia (HA) rarely require transfer, and no specific recommendations are available for this purpose. In patients who are admitted to a health care facility, transfer depends mainly on the underlying condition or on complications of HA or premature atherosclerosis, such as myocardial infarction, arrhythmia, or hypotension.


See the list below:

  • Familial or genetically inheritable forms of HA are not amenable to prevention. Genetic counseling and screening may be applicable in rare cases.
  • Hypoalphalipoproteinemia resulting from secondary causes can frequently be managed by treating those causes. Examples include quitting smoking and initiating regular physical activity.


See the list below:

  • Premature atherosclerosis
  • Corneal opacification


See the list below:

  • If hypoalphalipoproteinemia (HA) is diagnosed early and monitored closely, the prognosis for patients with HA is generally reasonably good. The risk derives from the development of complications.

Patient Education

See the list below:

Contributor Information and Disclosures

Vibhuti N Singh, MD, MPH, FACC, FSCAI Clinical Assistant Professor, Division of Cardiology, University of South Florida College of Medicine; Director, Cardiology Division and Cardiac Catheterization Lab, Chair, Department of Medicine, Bayfront Medical Center, Bayfront Cardiovascular Associates; President, Suncoast Cardiovascular Research

Vibhuti N Singh, MD, MPH, FACC, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Florida Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Yoram Shenker, MD Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Ghassem Pourmotabbed, MD, MD 

Ghassem Pourmotabbed, MD, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Endocrine Society

Disclosure: Nothing to disclose.

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Table. Hypoalphalipoproteinemia
VariantMolecular DefectInheritanceMetabolic DefectLipoprotein AbnormalityClinical FeaturesPremature Atherosclerosis
Familial apo A-IApo deficiencyAutosomal codominantAbsent apo A-1 biosynthesisHDL < 5 mg/dL; TGs normalPlanar xanthomas, corneal opacitiesYes
Familial apo A-I structural mutationsAbnormal apo A-IAutosomal dominantRapid apo A-1 catabolismHDL 15-30 mg/dL; TGs increasedOften none; sometimes corneal opacitiesNo
Familial LCATLCAT deficiency (complete)Autosomal


Rapid HDL catabolismHDL < 10 mg/dL; TGs increasedCorneal opacities, anemia, proteinuria, renal insufficiencyNo
Fish-eye diseaseLCAT deficiency (partial)Autosomal recessiveRapid HDL catabolismHDL < 10 mg/dL; TGs increasedCorneal opacitiesNo
Tangier diseaseUnknownAutosomal codominantVery rapid HDL catabolismHDL < 5 mg/dL; TGs usually increasedCorneal opacities, enlarged orange tonsils, hepatosplenomegaly, peripheral neuropathyNo to yes
Familial HAUnknownAutosomal dominantUsually rapid HDL catabolismHDL 15-35 mg/dL; TGs normalOften none; sometimes corneal opacitiesNo to yes
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