From the Guidelines
A non-HDL cholesterol level of 142 mg/dL is considered borderline high, and lifestyle modifications are recommended to lower this level and reduce the risk of cardiovascular disease. According to the 2013 ACC/AHA guideline 1, a non-HDL cholesterol level of 142 mg/dL falls into the borderline high category, which is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). The optimal non-HDL cholesterol level is below 130 mg/dL, and achieving this level can help reduce the risk of ASCVD.
To manage a non-HDL cholesterol level of 142 mg/dL, the following lifestyle modifications are recommended:
- Focus on a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins while limiting saturated fats, trans fats, and refined carbohydrates
- Engage in regular physical activity of at least 150 minutes of moderate exercise per week
- Maintain a healthy weight
- Avoid tobacco and limit alcohol consumption
Non-HDL cholesterol represents all potentially atherogenic (artery-clogging) lipid particles, including LDL, VLDL, and other triglyceride-rich lipoproteins, making it a valuable predictor of cardiovascular risk 2, 3. If you have other risk factors for heart disease, such as diabetes, hypertension, or a family history of early heart disease, your doctor may recommend more aggressive management, including medication, to lower your non-HDL cholesterol level and reduce your risk of ASCVD.
The most recent and highest quality study 3 suggests that non-HDL cholesterol is a better predictor of cardiovascular risk than LDL cholesterol, and that achieving a lower non-HDL cholesterol level can help reduce the risk of ASCVD. Therefore, lifestyle modifications and, if necessary, medication should be used to lower non-HDL cholesterol levels and reduce the risk of cardiovascular disease.
From the Research
Non-HDL Cholesterol Levels
- A non-HDL cholesterol level of 142 is considered elevated, as it is above the recommended levels for reducing the risk of atherosclerotic cardiovascular disease (ASCVD) 4.
- Elevated non-HDL cholesterol levels are associated with an increased risk of cardiovascular events, including myocardial infarction, stroke, and coronary revascularization 5.
Management of Elevated Non-HDL Cholesterol
- Statins are the primary treatment for lowering LDL-C and non-HDL cholesterol levels, and are well tolerated in most patients 6, 7.
- Non-statin therapies, such as ezetimibe, PCSK9 inhibitors, and bile acid sequestrants, can be used in combination with statins to further lower non-HDL cholesterol levels 6, 7, 5.
- The choice of treatment should be individualized based on the patient's risk factors, medical history, and response to treatment 6, 5.
Comparison of Non-HDL Cholesterol and ApoB as Treatment Targets
- Both non-HDL cholesterol and apoB are recognized as secondary treatment targets for reducing residual cardiovascular risk 8.
- ApoB is a direct measure of circulating numbers of atherogenic lipoproteins, and its measurement can be standardized across laboratories worldwide 8.
- Non-HDL cholesterol is calculated as total-HDL cholesterol, and includes the assessment of remnant lipoprotein cholesterol, an additional risk factor independent of LDL cholesterol 8.
- Discordance analysis suggests that apoB is the more accurate marker of cardiovascular risk, particularly in patients with mild-to-moderate hypertriglyceridemia, diabetes, obesity or metabolic syndrome, or very low LDL cholesterol [<70 mg/dL] [8].