Non-HDL Cholesterol

Non-HDL cholesterol is the cholesterol in all particles except HDL. You get it by subtracting your HDL from your total cholesterol; what remains is the cholesterol in LDL, in its precursors VLDL and IDL, and in Lp(a). Those are exactly the particles that carry an apoB protein and that can get stuck in the artery wall. Non-HDL therefore adds up all the cholesterol that can do harm, not only the part in LDL, but also the part in the triglyceride-rich particles that increase after a meal and with belly fat. It is the only cholesterol number you can work out yourself, from two values that are on every report, and at the same time it is the number your risk is estimated with in the Netherlands. If it is not on your report, subtract your HDL from your total; the calculator further down does it for you. And because HDL has been taken off, a high HDL can no longer hide a high LDL, which it can in total cholesterol. What you will not find for non-HDL is a normal value. Labs publish no range for it; they refer to the targets or print them themselves. The table further down shows how.

Non-HDL is the cholesterol number your risk of cardiovascular disease is estimated with in the Netherlands. There are three reasons. It counts the cholesterol in all the harmful particles, including the triglyceride-rich particles the LDL number misses. It stays reliable with high triglycerides, where the usual LDL calculation breaks down. And it costs nothing extra: total cholesterol and HDL are already on every fat profile, whereas apoB is a separate test that gives comparable information. For anyone who wants to stay healthy, non-HDL is therefore the number that shows most honestly what can end up in your artery wall, and it responds to everything you do yourself: food, weight, exercise. Since 2024 the Dutch risk estimate has used it instead of the ratio of total cholesterol to HDL. Anyone under treatment can steer by it just as well as by LDL; the table further down shows which non-HDL goes with which LDL target.

A high non-HDL means plenty of cholesterol in the particles that build up in the artery wall, and the causes are the same as for LDL: plenty of saturated fat, excess weight and little exercise, inheritance, an underactive thyroid, and rarely a kidney disease or familial hypercholesterolaemia. With belly fat and high triglycerides non-HDL climbs further than LDL, because it also counts the cholesterol in the triglyceride-rich particles; that is exactly where it is sharper. A low non-HDL is favourable, and there is no lower limit. In anyone who eats plant-based and fibre-rich, is lean and exercises a lot, it is the ordinary outcome; in others it is inheritance or the effect of cholesterol-lowering medication. The levers are the same as for LDL: olive oil instead of butter, nuts and oily fish instead of fatty meat and processed meat, fibre from oats, legumes, vegetables and fruit, losing weight around the middle and moving every day. Because non-HDL also counts the triglyceride-rich particles, less sugar and alcohol show up in it sooner than in LDL. For most people without an inherited condition that is the whole solution; with an inherited high cholesterol or existing cardiovascular disease, lifestyle remains the foundation and medication usually joins it. What counts as 'too high' depends on your overall risk, as with LDL. The targets in the table, below 2.6 or below 3.4 mmol/L, apply to anyone under treatment; separately, in non-fasting blood a value above 3.9 mmol/L stands out. If you are not under treatment there is no limit to reach, only a direction, and the levers above.