From the Guidelines
Non-HDL cholesterol encompasses all cholesterol types except high-density lipoprotein (HDL), primarily including low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and lipoprotein(a). It is calculated by subtracting HDL cholesterol from total cholesterol. Non-HDL cholesterol is clinically significant because it represents all potentially atherogenic (artery-clogging) lipoproteins in the bloodstream. These particles contain apolipoprotein B and can deposit cholesterol in arterial walls, contributing to atherosclerosis and cardiovascular disease. While LDL is often the primary target for cholesterol management, non-HDL provides a more comprehensive assessment of cardiovascular risk by capturing additional atherogenic particles. This measurement is particularly valuable for patients with elevated triglycerides, diabetes, or metabolic syndrome, where VLDL levels may be significantly elevated.
The most recent and highest quality study, 1, supports the use of non-HDL cholesterol as a secondary target of therapy, in addition to LDL cholesterol, to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). The study highlights that non-HDL cholesterol is more atherogenic than either LDL or VLDL alone and is highly correlated with apolipoprotein B levels.
Key points to consider:
- Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol.
- Non-HDL cholesterol represents all potentially atherogenic lipoproteins in the bloodstream, including LDL, VLDL, IDL, and lipoprotein(a).
- Non-HDL cholesterol is a secondary target of therapy in patients with elevated triglycerides, with a goal 30 mg/dL higher than the LDL cholesterol goal.
- The use of non-HDL cholesterol as a target of therapy is supported by recent clinical guidelines, including the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol, 1.
In clinical practice, target non-HDL levels are typically 30 mg/dL higher than LDL targets, reflecting the additional atherogenic particles beyond LDL. This approach is supported by the most recent and highest quality study, 1, which emphasizes the importance of non-HDL cholesterol in assessing cardiovascular risk and guiding therapy.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Components of Non-HDL Cholesterol
Non-HDL cholesterol encompasses all plasma lipoproteins except high-density lipoproteins (HDL) 2, 3, 4. The components of non-HDL cholesterol include:
- Low-density lipoprotein (LDL) 2, 3, 5, 4, 6
- Triglyceride-rich lipoproteins (TRL) 2, 3, 4
- TRL-remnants 2
- Lipoprotein a [Lp(a)] 2, 6
- Very low-density lipoprotein (VLDL) 5, 6
- Intermediate-density lipoprotein (IDL) 5, 6
- Chylomicrons and its remnants 6
Significance of Non-HDL Cholesterol
Non-HDL cholesterol is considered an independent risk factor or predictor for cardiovascular disease (CVD) 2, 3. It is recommended as a secondary goal for dyslipidemia management by most international guidelines 2, 3. The measurement of non-HDL cholesterol has been shown to be more accurate than LDL-cholesterol in hypertriglyceridaemic individuals, non-fasting samples, and in those with very-low LDL-cholesterol concentrations 5.
Calculation of Non-HDL Cholesterol
Non-HDL cholesterol is calculated as total cholesterol minus HDL-cholesterol 3, 4. This calculation represents the cholesterol content of all atherogenic apolipoprotein B-containing lipoproteins 3.