From the Guidelines
The desirable range for non-HDL cholesterol is generally less than 100 mg/dL for individuals at higher cardiovascular risk, and less than 130 mg/dL for most adults, as supported by the most recent guidelines 1. Non-HDL cholesterol is calculated by subtracting HDL ("good") cholesterol from total cholesterol, effectively measuring all cholesterol carried by potentially atherogenic lipoproteins, including LDL, VLDL, IDL, and lipoprotein(a). This measurement provides a more comprehensive assessment of cardiovascular risk than LDL cholesterol alone, particularly in people with elevated triglycerides, diabetes, or metabolic syndrome. Non-HDL cholesterol is especially useful because it accounts for triglyceride-rich lipoproteins that contribute to plaque formation in arteries. Key factors to consider in managing non-HDL cholesterol levels include:
- The level of cardiovascular risk, with more aggressive targets for those at higher risk 1
- The presence of elevated triglycerides, which may require a secondary target for non-HDL cholesterol 1
- The use of lifestyle modifications, such as a heart-healthy diet and regular physical activity, as first-line approaches to manage non-HDL cholesterol levels 1
- The potential use of medications, such as statins or fibrates, to further reduce non-HDL cholesterol levels when lifestyle changes are insufficient 1. It is essential to note that non-HDL cholesterol levels should be interpreted in the context of individual risk factors and overall health status, as emphasized in the guidelines 1. For individuals with very high triglyceride levels (200-499 mg/dL), a non-HDL-C target of less than 130 mg/dL is recommended 1. Overall, managing non-HDL cholesterol levels is crucial for reducing the risk of cardiovascular disease, and a comprehensive approach that incorporates lifestyle modifications and, when necessary, medication is essential for achieving optimal outcomes 1.
From the Research
Desirable Ranges for Non-HDL Cholesterol
The desirable ranges for non-HDL cholesterol levels are not explicitly stated in the provided studies. However, the studies suggest that lower levels of non-HDL cholesterol are associated with a lower risk of cardiovascular disease.
Non-HDL Cholesterol and Cardiovascular Risk
- Non-HDL cholesterol is considered an independent risk factor for cardiovascular disease (CVD) 2.
- Studies have shown that individuals with higher baseline non-HDL cholesterol levels at a younger age are more prone to adverse CVD events at an older age 2.
- Non-HDL cholesterol is recommended as a secondary goal for dyslipidemia management by most international guidelines 2.
Reduction of Non-HDL Cholesterol
- Statin treatment can reduce non-HDL cholesterol levels, with high-intensity statins being more effective than low-intensity statins 3, 4.
- The reduction in non-HDL cholesterol levels is proportional to the pretreatment concentration, and individuals with higher cholesterol levels may benefit more from statin treatment 5.
- Rosuvastatin, simvastatin, and atorvastatin are effective in reducing non-HDL cholesterol levels, with high-intensity doses being more effective than low-intensity doses 4.
Residual Risk of Cardiovascular Events
- Non-HDL cholesterol can identify residual risk of cardiovascular events in patients with ischemic heart disease and well-controlled LDL cholesterol 6.
- Patients with higher non-HDL cholesterol levels are at increased risk of cardiovascular events and death, even if their LDL cholesterol levels are well-controlled 6.