Non-HDL cholesterol: What is it? What are the Ideal Levels?

The use of the non-high density lipoprotein (non-HDL cholesterol or non-HDL-C) has been suggested as a better tool to predict death from cardiovascular disease. Generally, when both your total cholesterol and your low-density lipoproteins (LDL) levels are high, your risk of cardiovascular disease is high too. But, heart attacks don’t occur only in people with high LDL levels. This suggests that LDL cholesterol (LDL-C) alone cannot assess accurately the risk of cardiovascular disease, hence the use of the non-HDL cholesterol.

What is it?

The non-HDL-C is defined as the difference between the value of total cholesterol and that of HDL, so it not only includes the LDL cholesterol but also includes the intermediate density lipoprotein (IDL) fractions and very low-density lipoproteins (VLDL).

Non-HDL-C = Total Cholesterol – HDL Cholesterol

Why is it important?

The importance of the analysis of non-HDL-C as a predictor and target for the treatment of cardiovascular disease is that other highly atherogenic lipoproteins are included as the remnants of VLDL, which, being small and dense molecules. The potential use of non-HDL cholesterol to predict the risk of death due to cardiovascular disease has been demonstrated by different studies, however, there are few studies where it has been evaluated as a predictor of the risk of cardiovascular disease development. On the other hand, Non-HDL cholesterol has been shown to be a predictor of mortality in men and women, as good as LDL cholesterol.

Better predictor than LDL-C

In studies of patients with hypertriglyceridemia (high triglycerides levels), it has been possible to establish a direct association between the values ​​of non-HDL-C and the risk of death due to cardiovascular disease, this correlation being better than that observed when evaluating LDL-C.

In the case of male patients with high levels of Non-HDL-C, they have twice the risk of death from cardiovascular disease than their counterparts with low levels, while in female patients, the risk of death was approximately two and a half times higher. This is of major importance, since high values ​​of LDL-C, have lower risk predictive power, especially in women.

Easier to determine than LDL-C

The determination of non-HDL cholesterol levels has certain advantages compared to the estimation of LDL levels by the Friedewald formula, since its estimation may be inadequate in subjects with dyslipidemias. Additionally, the non-HDL cholesterol can be determined even in patients who are not fasting. It is a quick and simple way to estimate cardiovascular risk, which requires only the total cholesterol and HDL values, for its determination. By including potentially atherogenic lipoproteins, its determination is very useful for the evaluation of treatments that reduce cardiovascular risk.

What are the ideal levels?

According to the National Cholesterol Education Program (NCEP), the non-HDL-C should be ideally at most 30 mg/dL higher than your ideal level of LDL-C. The following chart compares the ideal and risky ranges for both non-HDL cholesterol and LDL cholesterol.

non-HDL CholesterolCategoryLDL Cholesterol
Below 100 mg/dLIdeal when very high risk of heart attackBelow 70 mg/dL
Below 130 mg/dLIdeal for people with heart disease or diabetesBelow 100 mg/dL
From 130 to 159 mg/dLClose to idealFrom 100 to 129 mg/dL
From 160 to 189 mg/dLBorderline highFrom 130 to 159 mg/dL
From 190 to 219 mg/dLHighFrom 160 to 189 mg/dL
220 mg/dL and overVery high190 mg/dL and over
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