High-density lipoprotein (HDL) is a healthy type of cholesterol. Non-HDL cholesterol refers to the sum of all the unhealthy types that contribute to the accumulation of plaque in the blood vessels.

Healthcare professionals calculate non-HDL cholesterol by subtracting high-density lipoprotein (HDL) cholesterol from total cholesterol.

The current cholesterol treatment goal involves lowering low-density lipoprotein (LDL), or “bad” cholesterol, which accounts for most of the body’s cholesterol. However, some research indicates that non-HDL cholesterol may be a more accurate determinant of death from cardiovascular disease and heart conditions.

The treatment for any type of high cholesterol involves lifestyle changes such as eating a diet low in saturated fat, exercising regularly, and stopping smoking, if applicable. Doctors may also prescribe medications, such as statins and cholesterol-lowering drugs.

Read more to learn about what non-HDL cholesterol is, what levels are normal, how to manage it, and more.

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HDL cholesterol, also known as “good” cholesterol, helps remove “bad” cholesterol from the blood vessels.

All the other types of cholesterol are harmful as they contribute to the accumulation of plaque in the blood vessels, which can obstruct blood flow. This increases the risk of heart attack and stroke.

Non-HDL cholesterol is the sum of cholesterols other than HDL. These include:

  • Very low-density lipoproteins (VLDL): The liver produces these triglyceride-rich particles.
  • Intermediate density lipoproteins (IDL): These cholesterol-containing particles form when fat and muscle tissue remove triglycerides from VLDL.
  • Low-density lipoproteins (LDL): These particles come from VLDL and IDL. They account for most of the cholesterol in the body.
  • Lipoprotein (a), or Lp (a): Lp (a) is a specific type of LDL particle.
  • Chylomicrons: Cells of the intestinal lining make these particles to transport triglycerides and cholesterol to the liver and peripheral tissues. These particles are larger after eating a high fat meal.

If a person has high non-HDL cholesterol levels, they may have an increased risk of heart disease.

According to a 2017 study, non-HDL cholesterol may be a more accurate indicator of cardiovascular death risk than LDL. The research indicates that even when people lower their LDL cholesterol to levels within a healthy range, they still have a residually high risk of coronary heart disease.

The authors of the study note that some of this risk may be due to co-occurring conditions rather than cholesterol levels. Examples include diabetes and high blood pressure, along with lifestyle habits, such as smoking and physical inactivity.

However, they believe that non-HDL levels could account for a portion of the residual risk.

A 2018 study shows how high non-HDL levels may forecast cardiovascular death. It followed 36,375 participants for a median of approximately 27 years to determine the relationship between non-HDL levels and the risk of death.

The authors found that levels equal to or greater than 160 milligrams per deciliter (mg/dl) were linked to a 50–80% higher risk of death from cardiovascular disease. They also discovered that non-HDL levels in the range of 130–160 mg/dl were associated with higher cardiovascular death rates. However, the participants all had a low 10-year risk of cardiovascular disease, so the results may not be generalizable to the wider population.

The chart below shows normal and high non-HDL levels:

Non-HDL cholesterolLevel
normalless than 130 mg/dl
highmore than 130 mg/dl

Although levels lower than 130 mg/dl may indicate a normal non-HDL level, doctors may set a person’s target levels considerably lower.

The medical community has traditionally stated that the goal for non-HDL cholesterol should be 30 mg/dl higher than the goal of LDL. For example, if a person is aiming for LDL levels of less than 70 mg/dl, their goal for non-HDL should be less than 100 mg/dl. However, some researchers question this approach.

High cholesterol typically does not produce symptoms. Many people with the condition remain unaware until they have a cardiac event. This is why healthcare professionals usually check cholesterol levels at yearly well-checks.

Doctors use a blood test called a lipid profile to diagnose the condition.

The chart below shows the types of cholesterol it measures and the optimal amounts:

Type of cholesterolAmount
total cholesterolapproximately 150 mg/d
LDLapproximately 100 mg/dl
HDLgreater than or equal to 50 mg/dl in females and 40 mg/dl in males
triglyceridesless than 150 mg/dl

Based on these results, a doctor can calculate non-HDL. If it exceeds 130 mg/dl, an individual has high non-HDL cholesterol.

Treating high cholesterol involves lifestyle adjustments and medication.

Lifestyle adjustments

Adopting a healthy lifestyle is part of any treatment of high cholesterol. A person may need to make various modifications, including:

  • Eating heart-healthy foods: This involves limiting foods high in saturated fat and eating nutritious foods, such as fruits, vegetables, and whole grains.
  • Engaging in regular exercise: Research indicates that this increases HDL while lowering LDL and triglycerides.
  • Managing stress: Long-term stress can reduce HDL and raise LDL.
  • Reaching or maintaining a moderate weight: If a person has excess weight, lowering body fat can increase HDL and lower LDL.
  • Quitting smoking, if applicable: Stopping smoking reduces the risk of cardiovascular disease.
  • Limiting alcohol consumption: Research has linked heavy alcohol consumption to a higher risk of cardiovascular disease.
  • Getting enough sleep: This helps repair and heal the heart and blood vessels.

Learn more about lifestyle changes to reduce cholesterol.

Medications

Statins are the most common class of medications for the treatment of high cholesterol.

Evidence suggests that treatment with lipid-lowering drugs from other classes is often necessary alongside statins to reduce non-HDL levels sufficiently.

Learn more about medications to lower cholesterol.

Non-HDL cholesterol denotes the amount of harmful cholesterol in a person’s body. A normal level for people aged 20 years and older is less than 130 mg/dl.

There are usually no symptoms associated with high cholesterol, so doctors tend to diagnose it with a lipid profile test.

People can often manage high cholesterol with healthy lifestyle practices, such as eating a nutritious diet, exercising regularly, and maintaining a moderate weight. Additional treatment may involve statins and other cholesterol-lowering medications.