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Low HDL (summary and causes of)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

High-density lipoprotein cholesterol (HDL-C) levels are inversely associated with coronary heart disease, independent of total and low-density lipoprotein cholesterol (LDL-C) levels. Low HDL-C may be secondary to factors such as:

  • cigarette smoking
  • obesity - particularly visceral fat
  • very low fat diets e.g. vegetarian often have low HDL-C
  • drugs, including:
    • beta-adrenergic blocking agents (beta-blockers)
    • anabolic steroids such as testosterone
    • androgenic progestins

However some individuals low HDL-C levels may have a genetic, or primary, cause, including abnormalities in:

  • ApoA-I
    • complete apoA-I deficiency
    • ApoA-I mutations (eg, ApoA-I Milano)
  • lecithin:cholesterol acyl transferase (LCAT)
    • complete LCAT deficiency
    • partial LCAT deficiency (fish-eye disease)
  • ABC1
    • Tangier disease
      • homozygous
      • heterozygous
    • Familial hypoalphalipoproteinemia (some families)
  • unknown genetic aetiology
    • Familial hypoalphalipoproteinemia (most families)
    • Familial combined hyperlipidemia with low HDL-C
    • metabolic syndrome


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  6. Knopp RH, Walden CE, Retzlaff BM, et al. Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men: the Dietary Alternatives Study. JAMA.1997;278:1509-1515.
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