Non-HDL cholesterol - blood test to assess the risk of cardiovascular disease
Non-HDL cholesterol is a calculation that shows how much cholesterol is in the body's atherogenic (vascular-damaging) lipoproteins. In short, a value for all cholesterol-carrying particles except HDL. Unlike individual LDL cholesterol, non-HDL also includes VLDL, IDL and so-called remnant particles, which provides a broader and more complete picture of cardiovascular risk.
Non-HDL cholesterol is automatically calculated by the laboratory according to the formula: Total cholesterol − HDL cholesterol. This means that no additional analyzer is required as long as total cholesterol and HDL analyses are included when purchasing the analysis.
Non-HDL has become a key marker in modern risk assessment
Non-HDL cholesterol has gained an increasingly important role in cardiovascular prevention and is used today both clinically and in risk models. A major advantage is that non-HDL is a robust measure even in non-fasting tests and in cases of elevated triglycerides, where LDL cholesterol can sometimes be less reliable. Non-HDL is also used in the European risk models SCORE2 and SCORE2-OP, which estimate the 10-year risk of heart attack and stroke. This makes non-HDL particularly relevant for those who want to make a structured and modern assessment of your cardiovascular risk.
What affects non-HDL levels?
Non-HDL cholesterol is affected by several factors, both lifestyle-related and medical:
- Diet: A high intake of saturated fats, trans fats and a higher energy diet can raise non-HDL.
- Overweight and abdominal obesity: Often leads to increased amounts of VLDL and remnant particles.
- Diabetes and insulin resistance: Associated with a more atherogenic lipid profile.
- Smoking and physical inactivity: Worsen blood lipids and increase cardiovascular risk.
- Genetics: Hereditary blood lipid disorders can result in significantly elevated levels.
- Thyroid disorders: Hypothyroidism can negatively affect cholesterol metabolism.
Why should I measure my non-HDL cholesterol?
Non-HDL cholesterol provides a clear picture of the portion of cholesterol that contributes to atherosclerosis. The analysis is used to:
- Assess the risk of cardiovascular disease, including via SCORE2/SCORE2-OP.
- Get a more comprehensive risk measure than LDL cholesterol alone.
- Monitor the effects of lifestyle changes such as diet, exercise and weight loss.
- Evaluate lipid-lowering treatment.
The analysis of non-HDL is particularly relevant if you:
- Have high blood pressure, type 2 diabetes or metabolic syndrome.
- Are overweight or have elevated triglycerides.
- Have a family history of premature cardiovascular disease.
- Want to monitor your cardiovascular risk over time.
What does a high non-HDL value?
An elevated non-HDL cholesterol means that the amount of cholesterol in the blood vessel-damaging lipoproteins is higher than desired. Over time, this can contribute to atherosclerosis and increase the risk of heart attack, stroke and other cardiovascular disease. The advantages of non-HDL are that it is easy to follow over time and often clear effects of treatment.
General target levels for non-HDL cholesterol in cardiovascular risk
Non-HDL cholesterol is always interpreted in relation to the individual cardiovascular risk. In European guidelines, non-HDL is used as a secondary treatment goal, especially in people at high risk.
