From the Guidelines
Non-HDL cholesterol is the sum of VLDL-, IDL- and LDL cholesterol, and is calculated by subtracting HDL cholesterol from total cholesterol, making it a better predictor of cardiovascular risk than LDL cholesterol alone. This is because non-HDL cholesterol captures all atherogenic (artery-clogging) particles, including LDL, VLDL, and other cholesterol-carrying particles 1. The calculation of non-HDL cholesterol is simple and does not require fasting before blood tests, unlike LDL cholesterol, which can be affected by triglyceride levels and requires a relatively long period of fasting 1.
Key Points
- Non-HDL cholesterol is a better predictor of cardiovascular risk than LDL cholesterol alone because it captures all atherogenic particles 1
- Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol 1
- The goal for non-HDL cholesterol is to keep it below 130 mg/dL, though target levels may vary based on individual risk factors 1
- Lifestyle modifications such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight, and avoiding tobacco can help lower non-HDL cholesterol 1
- Medications such as statins, ezetimibe, or PCSK9 inhibitors may be prescribed by a doctor if lifestyle modifications are not sufficient 1
Importance of Non-HDL Cholesterol
Non-HDL cholesterol is an important measure of cardiovascular risk because it captures all atherogenic particles, including LDL, VLDL, and other cholesterol-carrying particles 1. This is in contrast to LDL cholesterol, which only measures one type of atherogenic particle. The use of non-HDL cholesterol as a measure of cardiovascular risk is supported by several studies, including the Health Professionals Follow-up Study, the Framingham Heart Study, and the Women’s Health Study 1.
Calculation and Measurement
Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol, making it a simple and valuable measurement that does not require fasting before blood tests 1. This is in contrast to LDL cholesterol, which can be affected by triglyceride levels and requires a relatively long period of fasting. The calculation of non-HDL cholesterol is also less prone to error than the calculation of LDL cholesterol, which can be affected by various factors such as laboratory methods and instrumentation 1.
From the Research
Definition of Non-HDL Cholesterol
- Non-HDL cholesterol is determined by subtracting the high-density lipoprotein (HDL) cholesterol level from the total cholesterol level 2.
- It encompasses not only low-density lipoprotein (LDL) cholesterol but also the cholesterol contained in atherogenic, triglyceride-rich particles like remnants 2.
- Non-HDL cholesterol includes all plasma lipoproteins like LDL, triglyceride-rich lipoproteins (TRL), TRL-remnants, and lipoprotein a [Lp(a)] except high-density lipoproteins (HDL) 3.
Relationship to Cardiovascular Disease
- Non-HDL cholesterol levels are closely linked to measures of obesity, especially visceral obesity, and are related to atherosclerosis severity and subsequent cardiovascular morbidity and mortality 2.
- Several studies show that non-HDL cholesterol levels relate to cardiovascular disease, and pharmacologically induced changes in non-HDL cholesterol levels relate to prognosis 2.
- Non-HDL cholesterol is considered an independent risk factor or predictor for cardiovascular disease (CVD) and is recommended as a secondary goal for dyslipidemia management by most international guidelines 3.
Calculation and Measurement
- Non-HDL cholesterol can be easily estimated and is not dependent on fasting status, making it a reliable goal for dyslipidemia management 3.
- It is better at predicting atherosclerotic cardiovascular disease (ASCVD) risk in patients on statin therapy, and/or in those with obesity, diabetes, and metabolic disorders 3.