Low HDL Cholesterol (Hypoalphalipoproteinemia) Clinical Presentation

Updated: May 21, 2021
  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: George T Griffing, MD  more...
  • Print


Persons with low high-density lipoprotein (HDL) cholesterol levels, except those patients with a deficiency syndrome, have no symptoms specific to the condition. However, they may have a history of premature atherosclerosis, as well as a history consistent with coronary heart disease (CHD), peripheral artery disease, or other such conditions, including the following:

  • Premature atherosclerosis

    • CHD - A history of angina or myocardial infarction (MI) in a person below age 60 years, a history of premature heart disease in a patient's siblings and first-degree relatives, sequelae of MI

    • Congestive heart failure

    • Peripheral vascular disease - A history of claudication

  • Cerebrovascular disease

    • History of stroke

    • History of transient ischemic attack

    • History of carotid endarterectomy

  • Xanthomas (tendinous, cutaneous)

  • History consistent with secondary causes

    • Cigarette smoking

    • Physical inactivity

    • Hypertriglyceridemia

    • Renal disease

    • Obesity

    • Medications

    • Androgens

    • Progestins

    • Probucol

    • High-dose thiazides

    • High-dose beta blockers

  • Corneal opacification


Physical Examination

Persons with the common low high-density lipoprotein (HDL) syndromes have no specific physical findings. If atherosclerosis is present, the examination may reveal findings consistent with the affected arterial bed. These may include the following:

  • Tendon xanthomas

  • Cutaneous xanthomas

  • Findings of ischemic coronary heart disease or peripheral vascular disease

    • S4 gallop consistent with ischemic left ventricular dysfunction

    • Signs of congestive heart failure, such as a raised jugular distension, crackles at the lung bases, edema, and hepatomegaly

    • Arrhythmias

  • Corneal opacification