Low HDL (summary and causes of)

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

References:

1. Genest JJ Jr, Martin-Munley SS, McNamara JR, et al. Familial lipoprotein disorders in patients with premature coronary artery disease. Circulation. 1992;85:2025-2033.
2. Assmann G, von Eckardstein A, Funke H. High-density lipoproteins, reverse transport of cholesterol, and coronary artery disease: insights from mutations. Circulation. 1993;87:III-28-III-34
3. Lawn RM, Wade DP, Garvin MR, et al. The Tangier disease gene product ABC1 controls the cellular apolipoprotein-mediated lipid removal pathway. J Clin Invest. 1999;104:425-431.
4. Criqui MH, Wallace RB, Heiss G, et al. Cigarette smoking and plasma high-density lipoprotein cholesterol: the Lipid Research Clinics Program Prevalence Study. Circulation. 1980;62:IV70-IV76
5. Glueck CJ, Taylor HL, Jacobs D, et al. Plasma high-density lipoprotein cholesterol: association with measurements of body mass. The Lipid Research Clinics Program Prevalence Study. Circulation. 1980;62:IV62-IV69.
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.
7. van Brummelen P. The relevance of intrinsic sympathomimetic activity for beta-blocker-induced changes in plasma lipids. J Cardiovasc Pharmacol. 1983;5:S51-S55.
8. Sacks FM, Gerhard M, Walsh BW. Sex hormones, lipoproteins, and vascular reactivity. Curr Opin Lipidol. 1995;6:161-166.
9. Teran AZ, Greenblatt RB, Chaddha JS. Changes in lipoproteins with various sex steroids. Obstet Gynecol Clin North Am. 1987;14:107-119.