Understanding Non-HDL Cholesterol: A Comprehensive Overview

Image by Harvard Health 2022.

by Rosabel Zohfeld, APRN, MSN-Ed, FNP-C

Perhaps every year during an annual physical, your provider checks your lipids (cholesterol levels) as part of a routine examination. This blood test helps evaluate the risk of developing heart disease and other cardiovascular conditions. While looking at the laboratory report, did you wonder what that meant?

Let's review the main components of a lipid panel.

1. Total Cholesterol: This is the total amount of cholesterol in the blood, including low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol.
2. Low-Density Lipoprotein (LDL) Cholesterol: Often called "bad" cholesterol, this cholesterol carries cholesterol from the liver to the cells. High LDL levels can contribute to the buildup of plaque in the arteries (atherosclerosis), leading to heart disease and stroke.
3. High-density lipoprotein (HDL) Cholesterol: The so-called "good" cholesterol. Its job is to help remove LDL cholesterol, the bad cholesterol, from the bloodstream and transport it to the liver for excretion. Higher HDL levels are associated with a reduced risk of heart disease.
4. Triglycerides: Triglycerides are a type of fat found in the blood and are stored in fat cells. Elevated triglycerides are associated with a higher risk of heart disease, especially when combined with high LDL and low HDL cholesterol.
5. Non-High-Density Lipoprotein (Non-HDL) Cholesterol: As mentioned earlier, this is calculated by subtracting HDL cholesterol from the total cholesterol. It includes LDL cholesterol and other atherogenic lipoproteins, providing a more comprehensive cardiovascular risk assessment.
6. Very Low-Density Lipoprotein (VLDL) Cholesterol: VLDL is a lipoprotein carrying triglycerides that can be converted into LDL cholesterol.

What is precisely non-HDL cholesterol?

Non-HDL (Non-High-Density Lipoprotein) cholesterol is a type of cholesterol that includes all the cholesterol carried in lipoproteins other than high-density lipoprotein (HDL). Unlike HDL cholesterol, which is often referred to as "good" cholesterol because it helps remove low-density lipoprotein (LDL) cholesterol from the bloodstream, non-HDL cholesterol includes LDL cholesterol, very-low-density lipoprotein (VLDL) cholesterol and intermediate-density lipoprotein (IDL) cholesterol.

Here's some essential information about non-HDL cholesterol:

1. Composition: Non-HDL cholesterol includes LDL, VLDL, and IDL cholesterol. It represents a combination of atherogenic lipoproteins associated with an increased risk of cardiovascular disease.
2. Calculation: Non-HDL cholesterol is calculated by subtracting HDL cholesterol from the total cholesterol level. The formula is Non-HDL cholesterol = Total cholesterol - HDL cholesterol.
3. Atherogenicity: Non-HDL cholesterol is a better predictor of cardiovascular risk than LDL cholesterol alone. It accounts for all the cholesterol within atherogenic lipoproteins, providing a more comprehensive risk assessment.
4. Cardiovascular Risk: An elevated level of non-HDL cholesterol increases the risk of atherosclerosis, cardiovascular disease, heart attacks, and strokes.
5. Management and Treatment: Lowering non-HDL cholesterol through lifestyle changes (e.g., diet, exercise) and, if necessary, medication (e.g., statins) is an essential strategy for managing cardiovascular risk.
6. Recommended Levels: According to guidelines from organizations like the American Heart Association, the optimal level of non-HDL cholesterol is typically 30 mg/dL higher than the recommended LDL cholesterol level. Individuals with existing heart disease or diabetes may have more aggressive non-HDL cholesterol targets.
7. Diet and Lifestyle: Dietary modifications should help reduce saturated and trans fats, increase fiber intake, and incorporate heart-healthy foods, which can help lower non-HDL cholesterol. Getting regular physical activity as well as weight management are also important.
8. Monitoring: Non-HDL cholesterol levels should be monitored regularly, especially in individuals with a history of heart disease or those at high risk for cardiovascular events.

In summary, non-HDL cholesterol is a valuable marker for assessing cardiovascular risk, encompassing multiple types of cholesterol within atherogenic lipoproteins. Lowering non-HDL cholesterol levels is a critical component of managing and reducing the risk of cardiovascular disease.