Cholesterol

Non-HDL Cholesterol: Overview and More – Verywell Health

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Non-HDL cholesterol refers to all your cholesterol values minus your HDL cholesterol.

When a healthcare professional draws blood to evaluate your cholesterol levels, they usually report four numbers:

  • Low-density lipoprotein (LDL) cholesterol: Often deemed “bad” cholesterol because of its propensity to build up in the arteries and contribute to plaque formation, the central component of atherosclerosis
  • High-density lipoprotein (HDL) cholesterol: Often deemed “good” cholesterol because it helps the body rid itself of excess cholesterol that may potentially clog the arteries
  • Triglycerides: A type of fat (lipid) found in your blood
  • Total cholesterol: Includes all of the above

In essence, non-HDL cholesterol is a measure of the not-so-good cholesterol levels in your body. The higher your non-HDL levels, the greater your risk of cardiovascular disease. 

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Types of Non-HDL Cholesterol

Non-HDL is calculated from a lipid profile (non-HDL-C equals total cholesterol minus HDL-C). The main components of total cholesterol are LDL and triglycerides.

Total Cholesterol

This is a measure of all the fatty lipid components in the body, including:

Low-Density Lipoprotein

LDL is a protein that transports cholesterol to and from cells. Because LDL mainly performs the job of carrying cholesterol to cells, high levels may cause plaque formation. This can cause arteries to narrow and harden. Plaque rupture may result in a heart attack or stroke.

Triglycerides

Triglycerides are the most common type of fat in the body and store excess energy from your diet. High levels can increase heart disease risk, especially when combined with low HDL-C and high LDL-C levels.

Symptoms

Our body makes up all or most of the cholesterol we need to stay healthy, so we don’t need to consume too much in our diet. Lifestyle choices often contribute to high non-HDL levels, but you may be unaware of it since symptoms of high cholesterol levels may not be apparent.  

High cholesterol levels are usually detected on a blood test in the absence of symptoms, but you should be aware of the following warning signs:

  • Chest pain: High cholesterol levels can cause atherosclerotic plaque formation and vessel narrowing. If you experience chest pain, you may be having a heart attack, so seek immediate medical attention.
  • Fatty deposits around the body, called xanthomas
  • Cholesterol deposits on the eyelid, called xanthelasmas
  • Fatty, yellow deposits of cholesterol on the skin, elbows, knees, under the eyes, or around the eyelids

Causes

Some people inherit defective cholesterol transporting genes from their parents, a condition called familial hypercholesterolemia that results in abnormally high cholesterol levels. But for most people an unhealthy lifestyle is the culprit. 

 Behaviors that can negatively affect your cholesterol levels include:

  • Consuming an unhealthy diet, mainly from saturated fats in our diet—like read meat and full-fat dairy
  • Lack of physical activity or a sedentary lifestyle
  • Smoking or exposure to tobacco smoke
  • Being overweight or obese

In addition to making lifestyle changes—like quitting smoking, maintaining a healthy weight, and sticking to an exercise routine—your doctor may suggest taking a statin. Statins are cholesterol-lowering drugs that can keep your non-HDL levels within a normal range. Statins are commonly used and have been proven to decrease one’s heart disease risk.

Diagnosis

A lipid panel is a blood test that shows your total cholesterol levels. As previously mentioned, LDL is “bad” cholesterol and HDL is “good” cholesterol, but you may also want to keep an eye on triglyceride levels because they also put you at higher risk of heart disease. 

Fasting Before a Lipid Test

Although a lipid test can be done with or without fasting, you are more likely to get accurate results by fasting, especially if your triglycerides are going to be measured. This means you can have nothing but water for nine to 12 hours before the test.

Once your lipid levels are calculated, a simple mathematical calculation is used to determine your non-HDL levels.

Non-HDL-C is calculated by subtracting total cholesterol from HDL cholesterol. Total cholesterol is made up of triglycerides plus the combination of cholesterol from atherogenic lipoproteins which includes LDL, VLDL, IDL (intermediate density lipoprotein), and lipoprotein-a cholesterol.

Optimal non-HDL levels are below 130 mg/dL for both adult men and women.

Optimal HDL levels are 40 mg/dL for adult men and 50 mg/dL for adult women. Levels below this increase your risk of heart disease.

Optimum triglyceride levels are below 150 mg/dL. Triglyceride levels above 200 mg/dL are especially concerning, as studies show this greatly increases an individual’s risk of developing atherosclerosis and heart disease.

LDL Levels

  • Optimal level: 100 mg/dL
  • Borderline high level: 100 to 129 mg/dL
  • Mildly high level: 130 to 159 mg/dL
  • High level: 160 to 189 mg/dL
  • Very high level: 190 mg/dL or above

Triglyceride Levels

  • Optimal level: Less than 100 mg/dL
  • Borderline high level: 100 to 149 mg/dL
  • High level: 150 to 499 mg/dL
  • Very high level (requiring immediate medical attention): 500 mg/dL or more

The test for non-HDL cholesterol isn’t usually part of screening for your total cholesterol, but your healthcare provider may check these levels if you have high blood pressure, diabetes, or other risk factors for heart disease.

Treatment

Lifestyle changes are the first line of defense against rising non-HDL levels. Healthy lifestyle measures include:

  • Lowering blood pressure
  • Managing diabetes by keeping blood sugar levels within appropriate ranges
  • Exercising: The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend 150 minutes of moderate-intensity exercise per week.
  • Eating a heart-healthy diet: This includes 10 to 20 grams of soluble fiber, low-sodium meals, and a diet high in fruits and vegetables. Also increasing fish oils, niacin, and fibrates in your diet have been shown to reduce non-HDL levels.
  • Quitting smoking and limiting alcohol use

Statins are also commonly used to lower non-HDL levels by curbing LDL-C levels. The level of statin used depends on the severity of your cholesterolemia. Statin therapy is divided into three categories based on intensity:

High intensity, aiming for at least a 50% reduction in LDL-C

  • Atorvastatin 40–80 mg daily
  • Rosuvastatin 20–40 mg daily

Moderate intensity, aiming at a 30% to 49% reduction in LDL-C

  • Atorvastatin 10–20 mg daily
  • Fluvastatin 80 mg daily
  • Lovastatin 40–80 mg daily
  • Pitavastatin 1–4 mg daily
  • Pravastatin 40–80 mg daily
  • Rosuvastatin 5–10 mg daily
  • Simvastatin 20–40 mg daily

Low intensity, aiming at an LDL-C reduction of less than 30%

  • Fluvastatin 20–40 mg daily
  • Lovastatin 20 mg daily
  • Pravastatin 10–20 mg daily
  • Simvastatin 10 mg daily


Non-statin drugs such as ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can be added to statin therapy or used alone to further lower cholesterol levels.

Summary

Non-HDL cholesterol is a measure of the not-so-good cholesterol levels in your body. The higher your non-HDL levels, the greater your risk of cardiovascular disease. This is often detected via blood test before any symptoms present.

A Word From Verywell 

Making even modest changes now can help to prevent significant medical issues later from high non-HDL levels. New research is finding that non-HDL levels are a better predictor of heart health than traditional LDL-C levels. Therefore it is important that you do all you can to reduce both triglycerides and bad cholesterol via diet and exercise to reduce your risk of heart attack and stroke.