What is Non-HDL Cholesterol?
Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol, and it represents the total cholesterol content of all atherogenic (plaque-forming) lipoproteins in your blood, including LDL, VLDL, intermediate-density lipoprotein (IDL), and lipoprotein(a). 1
Why Non-HDL Cholesterol Matters
Non-HDL cholesterol captures the complete burden of atherogenic particles that contribute to cardiovascular disease, making it a more comprehensive measure than LDL cholesterol alone. 2
Non-HDL cholesterol is particularly valuable when triglycerides are ≥200 mg/dL, because it accounts for remnant lipoproteins (cholesterol-rich particles left over from triglyceride metabolism) that LDL cholesterol misses entirely. 2
The American College of Cardiology recognizes non-HDL cholesterol as a powerful independent predictor of cardiovascular events, often outperforming LDL cholesterol in risk prediction. 2
Multiple large studies—including the Health Professionals Follow-up Study, Framingham Heart Study, and Women's Health Study—have demonstrated that non-HDL cholesterol predicts coronary heart disease better than LDL cholesterol. 1
Practical Advantages
Non-HDL cholesterol offers several clinical benefits over traditional LDL cholesterol measurement:
It can be calculated from a standard lipid panel without requiring fasting, making it more convenient for patients and eliminating the inaccuracies that arise from variable fasting states. 1
The calculation is simple and doesn't require complex equations or direct measurement methods that may be unreliable. 1
Non-HDL cholesterol remains accurate even when triglycerides are elevated or LDL levels are very low—situations where calculated LDL cholesterol becomes unreliable. 1
Treatment Targets
The American College of Cardiology establishes non-HDL cholesterol goals that are 30 mg/dL higher than corresponding LDL cholesterol goals for each risk category:
- High-risk patients: Non-HDL cholesterol goal <130 mg/dL (corresponding to LDL <100 mg/dL) 2
- Intermediate-risk patients: Non-HDL cholesterol goal <160 mg/dL (corresponding to LDL <130 mg/dL) 2
- Lower-risk patients: Non-HDL cholesterol goal <190 mg/dL (corresponding to LDL <160 mg/dL) 2
This 30 mg/dL difference represents the normal contribution of VLDL cholesterol to the total non-HDL cholesterol concentration. 1
Clinical Context
Non-HDL cholesterol becomes a secondary treatment target when triglycerides are between 200-500 mg/dL, after LDL cholesterol goals have been addressed. 1 This approach ensures that physicians treat the full spectrum of atherogenic lipoproteins, not just LDL particles.
In clinical trials like the Treating to New Targets (TNT) and IDEAL studies, on-treatment non-HDL cholesterol levels were better predictors of reduced cardiovascular events than LDL cholesterol levels, reinforcing its value as both a risk marker and treatment target. 1