How to Calculate Non-HDL Cholesterol

Non-HDL cholesterol refers to all your cholesterol values minus your HDL cholesterol. In essence, it is a measure of the not-so-good cholesterol levels in your body. The higher your non-HDL levels, the greater your risk of cardiovascular disease. 

What Is Non-HDL Cholesterol?

When a healthcare professional draws blood to evaluate your cholesterol levels, they usually report four numbers:

• Low-density lipoprotein (LDL) cholesterol: Often deemed “bad” cholesterol because it tends to build up in the arteries and contribute to plaque formation, the central component of atherosclerosis (hardening and narrowing of your arteries)
• High-density lipoprotein (HDL) cholesterol: Often deemed “good” cholesterol because it helps the body rid itself of excess cholesterol that may potentially clog the arteries
• Triglycerides: A type of fat (lipid) found in your blood
• Total cholesterol: Includes all of the above

Your non-HDL cholesterol is determined by subtracting your HDL cholesterol from your total cholesterol.

Importance of Measuring Non-HDL Cholesterol

A non-HDL cholesterol level isn't usually provided as part of your total cholesterol screening. However, research suggests that calculating your non-HDL cholesterol can provide a better picture of your risk of heart disease than LDL alone.

One reason for this is that the LDL level reported on your blood test is not actually measured in the lab. Rather, it is calculated from the other measurements.

Further, several formulas have been proposed for calculating the LDL level, and different laboratories use different formulas. This means that LDL values will vary to at least some extent in different labs.

In contrast, the value of non-HDL cholesterol is based on a simple and reproducible calculation (total cholesterol minus HDL cholesterol).

So, if you have high triglycerides or other risk factors for heart disease, your healthcare provider may want to evaluate your non-HDL cholesterol and discuss your levels with you.

Types of Non-HDL Cholesterol

Low-Density Lipoprotein

LDL is a protein that transports cholesterol to and from cells. Because LDL mainly performs the job of carrying cholesterol to cells, high levels may cause plaque formation. This can cause arteries to narrow and harden. Plaque rupture may result in a heart attack or stroke.

Very-low Density Lipoprotein (VLDL)

Your liver makes VLDL so, at normal levels, it's a healthy and necessary component of your blood. But, if levels rise too high, it may increase your risk of health problems like heart attack or stroke.

Intermediate-Density Lipoprotein (IDL)

IDLs are produced when fatty acids are released by VLDLs. Your liver either removes them or they are converted into LDL.

Triglycerides

Triglycerides are the most common type of fat in the body and store excess energy from your diet. High levels can increase heart disease risk, especially when combined with low HDL cholesterol and high LDL cholesterol levels.

Symptoms of High Non-HDL Cholesterol

Our body makes up all or most of the cholesterol we need to stay healthy, so we don’t need to consume too much in our diet. Lifestyle choices often contribute to high non-HDL levels, but you may be unaware of it since symptoms may not be apparent.  

High cholesterol levels are usually detected on a blood test in the absence of symptoms, but you should be aware of the following warning signs:

• Chest pain: High cholesterol levels can cause atherosclerotic plaque formation and vessel narrowing. If you experience chest pain, seek immediate medical attention.
• Xanthomas: Fatty deposits of cholesterol found on the skin, elbows, knees, and other parts of the body.
• Xanthelasmas: Fatty, yellow deposits of cholesterol found under the eyes, or around the eyelids.

Causes of High Non-HDL Cholesterol

Some people inherit defective cholesterol-transporting genes from their parents, a condition called familial hypercholesterolemia that results in abnormally high cholesterol levels. But for most people, an unhealthy lifestyle is the culprit. 

Behaviors that can negatively affect your cholesterol levels include:

• Consuming an unhealthy diet, including foods high in saturated fat like red meat and full-fat dairy
• Lack of physical activity or a sedentary lifestyle
• Smoking or exposure to tobacco smoke
• Being overweight or obese
  

Testing Non-HDL Cholesterol

A lipid panel is a blood test that shows your total cholesterol levels. As previously mentioned, LDL is “bad” cholesterol and HDL is “good” cholesterol, but keep an eye on triglyceride levels because they also put you at higher risk of heart disease. 

Once your lipid levels are determined, non-HDL cholesterol can be calculated by subtracting HDL cholesterol from total cholesterol. Total cholesterol is made up of all the cholesterol-containing lipoproteins in the blood, including LDL, VLDL, IDL, and HDL cholesterol. Simply subtracting the HDL cholesterol from this value yields non-HDL cholesterol.

Optimal non-HDL levels are below 130 mg/dL for both adult men and women.

Optimal HDL levels are 40 mg/dL for adult men and 50 mg/dL for adult women. Levels below this increase your risk of heart disease.

Optimum triglyceride levels are below 150 mg/dL. Triglyceride levels above 200 mg/dL are especially concerning, as studies show this greatly increases an individual’s risk of developing atherosclerosis and heart disease.

LDL Levels

• Optimal level: 100 mg/dL
• Borderline high level: 100 to 129 mg/dL
• Mildly high level: 130 to 159 mg/dL
• High level: 160 to 189 mg/dL
• Very high level: 190 mg/dL or above

Triglyceride Levels

• Optimal level: Less than 100 mg/dL
• Borderline high level: 100 to 149 mg/dL
• High level: 150 to 499 mg/dL
• Very high level (requiring immediate medical attention): 500 mg/dL or more

As mentioned, the test for non-HDL cholesterol isn’t usually part of screening for your total cholesterol, but your healthcare provider may check these levels if you have high blood pressure, diabetes, or other risk factors for heart disease.

Non-HDL Levels

Current cholesterol guidelines recommend a non-HDL cholesterol level of 30 mg/dL higher than your desired LDL cholesterol level. As an example, if you'd like to lower your LDL to 100 mg/dL, your non-HDL goal should be 130 mg/dL. Medical professionals advise lowering LDL and non-HDL cholesterol at the same time to limit your risk of heart disease.

If you have underlying health concerns such as diabetes, a family history of heart disease, or other risk factors (e.g., smoking), you and your healthcare provider should discuss your individual cholesterol level targets. You may need to aim for lower levels.

Treating High Non-HDL Cholesterol

Lifestyle Changes

Lifestyle changes are the first line of defense against rising non-HDL levels. Healthy lifestyle measures include:

• Lowering blood pressure
• Managing diabetes by keeping blood sugar levels within appropriate ranges
• Exercising: The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend 150 minutes of moderate-intensity exercise per week
• Eating a heart-healthy diet rich in whole grains, fruits, vegetables, and fish with high levels of omega-3 fatty acids like salmon, tuna, and mackerel
• Quitting smoking and limiting alcohol use

Medication

Statins are also commonly used to lower non-HDL levels by curbing LDL-C levels. The level of statin used depends on the severity of your cholesterolemia. Statin therapy is divided into three categories based on intensity:

High intensity, aiming for at least a 50% reduction in LDL-C

• Atorvastatin 40–80 milligrams (mg) daily
• Rosuvastatin 20–40 mg daily

Moderate intensity, aiming at a 30% to 49% reduction in LDL-C

• Atorvastatin 10–20 mg daily
• Fluvastatin 80 mg daily
• Lovastatin 40–80 mg daily
• Pitavastatin 1–4 mg daily
• Pravastatin 40–80 mg daily
• Rosuvastatin 5–10 mg daily
• Simvastatin 20–40 mg daily

Low intensity, aiming at an LDL-C reduction of less than 30%

• Fluvastatin 20–40 mg daily
• Lovastatin 20 mg daily
• Pravastatin 10–20 mg daily
• Simvastatin 10 mg daily

Non-statin drugs such as Zetia (ezetimibe) and PCSK9 inhibitors—Repatha (evolocumab), Praluent (alirocumab), and Leqvio (inclisiran)—can be added to statin therapy or used alone to further lower cholesterol levels.

Summary

Non-HDL cholesterol is a measure of the not-so-good cholesterol levels in your body. The higher your non-HDL levels, the greater your risk of cardiovascular disease. This is often detected via blood testing before any symptoms are present, but you might notice fatty, yellow deposits on your skin or have chest pain.

As with many health issues, poor diet, a lack of exercise, and habits like smoking contribute to high cholesterol levels. Lifestyle changes and medication can be used to lower non-HDL levels.