Non-HDL Cholesterol

What is non-HDL cholesterol?

Non-HDL cholesterol refers to all the cholesterol carried on particles other than high density lipoproteins (HDLs). It’s a number that captures the amount of “bad” cholesterol in your blood. This helps your healthcare provider understand your risk for heart disease. A higher number means a greater risk of problems like a heart attack or stroke.

Non-HDL includes cholesterol carried on these types of particles:

• Low-density lipoproteins (LDLs)
• Very-low-density lipoproteins (VLDLs)
• Intermediate-density lipoproteins (IDLs)
• Chylomicrons
• Triglyceride-rich lipoprotein (TRL) remnants
• Lipoprotein (a)

These particles are “bad” because they put cholesterol in your artery walls. Over time, this contributes to plaque buildup (atherosclerosis). You might hear your healthcare provider call non-HDL particles “atherogenic.” This means they play a major role in atherosclerosis.

HDL particles are different. They’re “good” because they carry away the excess cholesterol that the “bad” particles leave behind. HDLs take this cholesterol to your liver. From there, your body can get rid of it. You may hear your provider call this process “reverse cholesterol transport.” It helps reduce the amount of cholesterol circulating in your blood.

Why does non-HDL matter?

Your non-HDL cholesterol better predicts your risk for cardiovascular disease than LDL cholesterol. That’s because it captures not just one type of “bad” particle, but all of them.

Experts have found that non-HDL is especially helpful in assessing your risk if you have:

• High triglycerides
• Metabolic syndrome
• Obesity
• Type 2 diabetes

Your non-HDL number can also help show your “residual risk,” or the risk that remains even after lowering your LDL with statins. Sometimes, a low LDL isn’t enough to protect you against heart attack and stroke. High levels of other “bad” lipoproteins can still raise your risk. So, you may need other treatments. 

How do I calculate it?

You can calculate it by subtracting your HDL from your total cholesterol. For example, if your total cholesterol is 180 and your HDL is 60, then your non-HDL is 120 (180 minus 60). Like other cholesterol numbers, the unit of measurement for non-HDL is mg/dL (milligrams per deciliter).

A standard lipid panel will show your non-HDL number. You may not need to fast before the test (but always ask your healthcare provider). That’s because non-HDL is less likely than LDL to change in response to foods and drinks. This also means it provides a more realistic picture of what’s happening in your arteries from day to day.

What’s the normal range?

Your non-HDL cholesterol should be no more than 30 mg/dL higher than your LDL target. Most adults have an LDL target of below 100. So, that means their non-HDL should be below 130.

Your healthcare provider may set lower LDL and non-HDL targets based on your health history. For example, they may want you to target an LDL below 70. In that case, your non-HDL should be below 100. Your provider will explain what’s best in your case.

For children and teens, a non-HDL cholesterol level below 120 mg/dL is generally considered healthy. Levels at or above 160 mg/dL are considered high and may warrant closer follow-up.

What causes high non-HDL cholesterol?

Your non-HDL cholesterol may be high due to:

• Genetics: The genes you inherit play the biggest role in your non-HDL levels — especially for one type of non-HDL particle called lipoprotein (a). High non-HDL cholesterol tends to run in biological families. Some people inherit a genetic disorder that causes it.
• Diet: Certain foods can raise your non-HDL cholesterol. These are typically the same foods that raise LDL and triglycerides. Examples include foods high in saturated fat, trans fat and added sugar.
• Having overweight/obesity: Carrying excess weight may raise your non-HDL levels.
• Using tobacco: Smoking and other tobacco products, like smokeless tobacco and vaping, make your non-HDL go up.
• Not getting enough exercise: Physical activity helps support healthy cholesterol levels. If you don’t move around much, your non-HDL cholesterol may go up.

How can I lower it?

Your healthcare provider may prescribe one or more medicines to lower your non-HDL cholesterol. This is true even if you’re already on statins to lower your LDL levels. You may need additional medicines. This is because a high non-HDL can raise your risk for heart disease even if your LDL is where it’s supposed to be.

Your provider may also recommend:

• Dietary changes: Eating healthy fats and limiting saturated fats can help reduce your non-HDL cholesterol. Following the Mediterranean diet can help.
• Exercise: Aim for 150 minutes of moderate-intensity exercise per week. That includes things like walking, cycling and swimming. This can boost your “good” HDL cholesterol and drive down your non-HDL levels.
• Quitting tobacco use: This can help lower your non-HDL. Tobacco use is also a strong risk factor on its own for heart and blood vessel disease. So, quitting has many benefits aside from improving your cholesterol levels.

What is apolipoprotein B?

When reading about non-HDL cholesterol, you might also hear about apolipoprotein B, or apoB for short. This is a type of protein that’s found on every “bad” lipoprotein in your blood.

Research shows that apoB measurements are even more accurate at predicting risk than non-HDL. But for now, an apoB measurement isn’t part of a standard lipid panel. This is largely because treatment guidelines target LDL and non-HDL numbers rather than apoB numbers. That may change in the future.