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You may be familiar with the terms total cholesterol, HDL cholesterol, and LDL cholesterol. But what about non-HDL cholesterol—what is that, and what does it mean for your health?
Let’s break it down.
What is cholesterol?
Cholesterol is a waxy substance that’s found in almost every cell in your body. As one of your body’s main building blocks, it’s vital for your health. It’s an essential component of cell membranes that makes vitamin D, cortisol, sex hormones, bile salts, and more (Huff, 2021).
Your liver produces all the cholesterol you need. Cholesterol is also found in certain animal-derived foods, such as eggs and beef. Interestingly, though, the amount of cholesterol in your diet has almost no effect on cholesterol levels in your blood (Soliman, 2018; Blesso, 2018).
Cholesterol is carried in your bloodstream by small particles called lipoproteins. These particles constantly transport cholesterol between your liver and all the tissues of your body.
What are the different types of cholesterol?
The different types of cholesterol are named after the lipoprotein particles that transport them.
High-density lipoprotein (HDL) cholesterol is often called “good cholesterol.” It helps clear excess cholesterol from your blood by transporting it to your liver, which removes the unneeded cholesterol from your body.
Low-density lipoprotein (LDL) cholesterol (often called “bad cholesterol”) makes up about two-thirds of your cholesterol (Huff, 2021). As LDL cholesterol travels throughout your body, cells in need of cholesterol trap and take in the LDL particles. If the cells don’t need the LDL cholesterol, it remains in the bloodstream.
LDL cholesterol is dangerous because it can enter the walls of your arteries and form plaques. Plaques are hardened deposits that can build up in your blood vessels, clogging them and making them brittle. This condition is called atherosclerosis. Clogged blood vessels can cause many types of cardiovascular disease (CVD), including high blood pressure (hypertension), heart attack, and stroke.
Intermediate-density lipoprotein (IDL) cholesterol and very-low-density lipoprotein (VLDL) cholesterol particles carry triglycerides in your bloodstream.
Non-HDL cholesterol, as you might guess, is your total cholesterol level minus your HDL cholesterol level. So it’s the total of your LDL, IDL, and VLDL levels together.
Why is your non-HDL cholesterol level important?
Total cholesterol level isn’t a good indicator of CVD risk because it includes both good and bad cholesterol levels. The medical community used to think that LDL level was the most important indicator of CVD risk. Researchers found the ratio of total cholesterol to HDL cholesterol is a better indicator of CVD risk than just LDL levels alone.
More recently, researchers have found that non-HDL levels are as good as, or better than, both LDL levels and cholesterol ratios for predicting a higher risk of CVD. (Harari, 2017; Abdullah, 2018; Puri, 2016).
What is a healthy non-HDL cholesterol level?
Ideally, your non-HDL cholesterol level should be less than 130 milligrams per deciliter (mg/dL), or 3.37 millimoles per liter (mmol/L) (Su, 2019; Bittner, 2015).
How can you lower your non-HDL levels?
If your non-HDL levels are high, you may have an increased risk of developing cardiovascular disease. Talk with your healthcare provider, who may recommend you make some changes in your lifestyle. Cholesterol management almost always starts with lifestyle adjustments.
How to lower cholesterol: medication and lifestyle
These kinds of changes might include:
- Losing weight—If you have excess weight or even obesity, losing weight can help you lower your non-HDL levels.
- Diet—Minimize eating saturated fats and trans fats, which raise non-HDL levels. Eat a diet rich in fiber, vegetables, fruits, whole grains, lean meats, and fish. Consume omega-3 fats, found in flax, avocados, fatty fish, and fish-oil supplements (Zibaeenezhad, 2017).
- Exercise—Regular aerobic exercise can lower non-HDL levels (Huff, 2021).
In some cases, lifestyle modifications alone are not enough to lower your non-HDL levels. In that case, your healthcare provider may recommend a cholesterol-lowering medication. Follow your healthcare provider’s medical advice to treat high cholesterol and prevent cardiovascular disease.
- Abdullah, S. M., Defina, L. F., Leonard, D., Barlow, C. E., Radford, N. B., Willis, B. L., et al. (2018). Long-term association of low-density lipoprotein cholesterol with cardiovascular mortality in individuals at low 10-year risk of atherosclerotic cardiovascular disease. Circulation, 138(21), 2315–2325. doi: 10.1161/CIRCULATIONAHA.118.034273. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30571575/
- Bittner, V., Bertolet, M., Barraza Felix, R., Farkouh, M. E., Goldberg, S., Ramanathan, K. B., et al. (2015). Comprehensive cardiovascular risk factor control improves survival: The BARI 2D Trial. Journal of the American College of Cardiology, 66(7), 765–773. doi: 10.1016/j.jacc.2015.06.019. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26271057/
- Blesso, C. N., Fernandez, M. L. (2018). Dietary cholesterol, serum lipids, and heart disease: are eggs working for or against you? Nutrients, 10(4), 426. doi: 10.3390/nu10040426. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29596318/
- Harari, G., Green, M. S., Magid, A., & Zelber-Sagi, S. (2017). Usefulness of non-high-density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men in 22-year follow-up. The American journal of cardiology, 119(8), 1193–1198. doi: 10.1016/j.amjcard.2017.01.008. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28267961/
- Huff T, Boyd B, Jialal I. Physiology, Cholesterol. [Updated 2021 Mar 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470561/
- Puri, R., Nissen, S. E., Shao, M., Elshazly, M. B., Kataoka, Y., Kapadia, S. R., et al. (2016). Non-HDL cholesterol and triglycerides: implications for coronary atheroma progression and clinical events. Arteriosclerosis, thrombosis, and vascular biology, 36(11), 2220–2228. doi: 10.1161/ATVBAHA.116.307601. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27515380/
- Soliman, G. A. (2018). Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients, 10(6), 780. doi: 10.3390/nu10060780. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29914176/
- Su, X., Kong, Y., & Peng, D. (2019). Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol. Lipids in health and disease, 18(1), 134. doi: 10.1186/s12944-019-1080-x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554877/
- Zibaeenezhad, M. J., Ghavipisheh, M., Attar, A., & Aslani, A. (2017). Comparison of the effect of omega-3 supplements and fresh fish on lipid profile: a randomized, open-labeled trial. Nutrition & diabetes, 7(12), 1. doi: 10.1038/s41387-017-0007-8. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29259181/
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.