Further Inpatient and Outpatient Care

Further inpatient care

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.

Transfer

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.

Further outpatient care

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.

Inpatient and Outpatient Medications

Inpatient and outpatient medications include the following:

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

Deterrence/Prevention

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.

Questions

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Table. Hypoalphalipoproteinemia

Table. Hypoalphalipoproteinemia

Variant	Molecular Defect	Inheritance	Metabolic Defect	Lipoprotein Abnormality	Clinical Features	Premature Atherosclerosis
Familial apo A-I	Apo deficiency	Autosomal codominant	Absent apo A-1 biosynthesis	HDL < 5 mg/dL; TGs normal	Planar xanthomas, corneal opacities	Yes
Familial apo A-I structural mutations	Abnormal apo A-I	Autosomal dominant	Rapid apo A-1 catabolism	HDL 15-30 mg/dL; TGs increased	Often none; sometimes corneal opacities	No
Familial LCAT	LCAT deficiency (complete)	Autosomal recessive	Rapid HDL catabolism	HDL < 10 mg/dL; TGs increased	Corneal opacities, anemia, proteinuria, renal insufficiency	No
Fish-eye disease	LCAT deficiency (partial)	Autosomal recessive	Rapid HDL catabolism	HDL < 10 mg/dL; TGs increased	Corneal opacities	No
Tangier disease	Unknown	Autosomal codominant	Very rapid HDL catabolism	HDL < 5 mg/dL; TGs usually increased	Corneal opacities, enlarged orange tonsils, hepatosplenomegaly, peripheral neuropathy	No to yes
Familial HA	Unknown	Autosomal dominant	Usually rapid HDL catabolism	HDL 15-35 mg/dL; TGs normal	Often none; sometimes corneal opacities	No to yes

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Author

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 Physician Leadership, American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society, International Society for Clinical Densitometry, Southern Society for Clinical Investigation

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.