Non-High Density Lipoprotein Cholesterol

At a Glance

Why Get Tested?

To help determine your risk of developing cardiovascular disease (CVD); to monitor treatment

When To Get Tested?

For Screening when no risk factors present: for adults, every four to six years; for youths, once between the ages of 9 and 11 and again between ages 17 and 21

For Monitoring: at regular intervals when risk factors are present, when prior results showed high-risk levels, and/or to monitor effectiveness of treatment

Sample Required?

A blood sample drawn from a vein in your arm or from a fingerstick

Test Preparation Needed?

For a fasting lipid profile, fasting for 9-12 hours (water only) before having your blood drawn is typically required, but some labs offer non-fasting lipid testing. In particular, testing may be done without fasting for youths without risk factors. Follow any instructions you are given and tell the person drawing your blood whether or not you have fasted.

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Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Non-high-density lipoprotein cholesterol (non-HDL-C) is the total amount of cholesterol contained in lipoproteins other than high-density lipoprotein (HDL). HDL is a particle that contains cholesterol, which is called HDL cholesterol or HDL-C. Non-HDL-C is calculated from the results of a lipid profile by subtracting the HDL-C result from the total cholesterol.

Lipoproteins are responsible for the transport and metabolism of cholesterol. Low-density lipoproteins (LDL) transport cholesterol from the liver to other tissues, including blood vessel walls. Therefore, high LDL cholesterol (LDL-C) is considered to be associated with the development of hardening of the arteries (atherosclerosis) and cardiovascular disease (CVD). High density lipoproteins (HDL) have an inverse function – they transport cholesterol from the blood vessels to the liver, thus providing protection against CVD.

Monitoring and maintaining healthy levels of lipids is important for staying healthy. Eating too much of foods that are high in saturated fats and trans unsaturated fats (trans fats) or having an inherited predisposition can result in a high level of cholesterol in the blood. The extra cholesterol may be deposited in plaques on the walls of blood vessels. Plaques can narrow or eventually block the opening of blood vessels, leading to atherosclerosis and increased risk of numerous health problems, including heart disease and stroke. Additionally, rupture of plaque can cause a heart attack.

In the standard lipid profile, the level of total cholesterol and HDL-C are measured. LDL-C is usually not measured directly but is calculated from the results of the other components of the lipid profile, including total cholesterol, HDL cholesterol (HDL-C), and triglycerides. Non-HDL-C may be reported as part of the lipid profile. It reflects the amount of cholesterol in all fractions of lipoproteins that may contribute to your risk of heart disease (atherogenic): LDL, intermediate and very low density lipoproteins (IDL, VLDL) and lipoprotein a (Lp (a)).

How is the sample collected for testing?

The test requires a blood sample taken from a vein in the arm or from a fingerstick.

Is any test preparation needed to ensure the quality of the sample?

For a fasting lipid profile, which may include a results for non-HDL-C, fasting for 9-12 hours before having the blood sample drawn is typically required; only water is permitted. However, some laboratories offer non-fasting lipid profiles. In particular, children and teens may have testing done without fasting. Follow any instructions you are given and be sure to tell the person drawing your blood whether or not you have fasted.

Common Questions

How is it used?

Non-high-density lipoprotein cholesterol (non-HDL-C) may be calculated and reported as part of a lipid profile to help determine an individual’s risk of heart disease. Results of non-HDL-C and other components of the lipid profile may be considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up if there is intermediate or high risk. Treatment options may include lifestyle changes such as diet or exercise programs or lipid-lowering drugs such as statins. The components of the lipid profile may also be used to monitor the effectiveness of treatment once it is initiated.

When is it ordered?

The calculation of non-HDL-C can be reported as an additional parameter to the traditional lipid profile, along with total cholesterol, HDL-C, LDL-C and triglycerides when a person has a routine health exam.

Adults
It is recommended that all adults with no risk factors for heart disease be tested every four to six years.

For people who have one or more major risk factors for heart disease (see below), a fasting lipid profile may be ordered more frequently.

Major risk factors for heart disease other than a high LDL-C include:

Cigarette smoking
Being overweight or obese
Unhealthy diet
Being physically inactive, not getting enough exercise
Age (males 45 years or older or females 55 years or older)
High blood pressure (blood pressure of 140/90 or higher or taking high blood pressure medications)
Family history of premature heart disease (heart disease in a first degree male relative under age 55 or a first degree female relative under age 65)
Pre-existing coronary heart disease or already having had a heart attack
Diabetes or prediabetes
Low HDL-C and/or elevated triglycerides

Youth
For children and teens, routine lipid testing is recommended by the American Academy of Pediatrics once between the ages of 9 and 11 and again between the ages of 17 and 21. Earlier and more frequent screening with a lipid profile is recommended for children and youth who are at increased risk of developing heart disease and who have a family history of elevated cholesterol. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. High-risk children should have their first lipid profile between 2 and 8 years of age. Children younger than 2 years old are too young to be tested.

Non-HDL-C can also be reported along with a lipid profile periodically in order to assess the treatment of lipid disorders, both with diet, increased physical activity and after drug therapy, such as statins. Non-HDL-C is considered to be the second target, after LDL-C, of lipid-lowering therapy.

What does the test result mean?

In general, healthy lipid levels help to maintain a healthy heart and lower the risk of heart attack or stroke. A healthcare practitioner will take into consideration the results of non-HDL-C and the other components of a lipid profile as well as other risk factors to help determine a person’s overall risk of heart disease, whether treatment is necessary and, if so, which treatment will best help to lower the person’s risk.

Adults
In 2002, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) provided guidelines for evaluating lipid levels and determining treatment. However, in 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued guidelines for adults that made recommendations on who should receive cholesterol-lowing therapy, depending on age, presence of heart disease and/or diabetes, and LDL-C level.

In healthy adults with no heart disease, the decision to treat is based on a risk calculator that takes into account several factors (e.g., age, gender, race, blood pressure, cholesterol level) and determines the risk of having a heart attack or stroke in the next 10 years. A person with a 7.5% or higher risk should be prescribed statins, according to the ACC/AHA guidelines. Recent guidelines also recommend focusing on a percentage reduction in LDL-C rather than target values to reduce the risk of atherosclerotic cardiovascular disease (ASCVD).

However, use of the updated risk calculator and guidelines remains controversial. Many still use the older guidelines from the NCEP ATP III to evaluate lipid levels and heart disease risk. According to the NCEP, if a person has no other risk factors, a non-HDL level can be evaluated as follows:

Optimal:	Less than 130 mg/dL (3.37 mmol/L)
Near/above optimal:	130-159 mg/dL (3.37-4.12mmol/L)
Borderline high:	160-189 mg/dL (4.15-4.90 mmol/L)
High:	190-219 mg/dL (4.9-5.7 mmol/L)
Very high:	Greater than 220 mg/dL (5.7 mmol/L)

Youths

A full, fasting lipid profile is recommended for screening youths with risk factors for developing heart disease, according to the American Academy of Pediatrics. Fasting prior to lipid screening in children without risk factors is unnecessary. Non-HDL-C is the recommended test for non-fasting lipid screening. Recommended cut-off values include:

	Test	Acceptable	Borderline	High
Children and Teens	Total Cholesterol	Less than 170 mg/dL (4.40 mmol/L)	170-199 mg/dL (4.40-5.14 mmol/L)	Greater than or equal to 200 mg/dL (5.17 mmol/L)
	Non-HDL Cholesterol	Less than 120 mg/dL (3.11 mmol/L)	120-144 mg/dL (3.11-3.73 mmol/L)	Greater than or equal to 145 mg/dL (3.76 mmol/L)
Young Adults	Total Cholesterol	Less than 190 mg/dL (4.91 mmol/L)	190-224 mg/dL (4.91-5.79 mmol/L)	Greater than or equal to 225 mg/dL (5.81 mmol/L)
	Non-HDL Cholesterol	Less than 150 mg/dL (3.89 mmol/L)	150-189 mg/dL (3.89-4.90 mmol/L)	Greater than or equal to 190 mg/dL (4.92 mmol/L)

Low levels of non-HDL-C, as well as LDL-C, are not usually a cause for concern and do not require monitoring. This state might occur in hyperthyroidism, liver diseases or inherited deficiency of lipoproteins.

Is there anything else I should know?

Since non-HDL-C is a calculated parameter, the measurement of total cholesterol and HDL-C must be performed first.

The concentration of non-HDL-C, like LDL-C, may temporarily decrease due to acute infections, myocardial infarction or injury. Higher concentrations can be observed in pregnant women. Accordingly, the assay should be performed in relatively healthy patients. Otherwise, the determination should be done about 6 weeks after disease or giving birth.

How is non-HDL cholesterol calculated?

The level of non-HDL cholesterol (non-HDL-C) is calculated from the total cholesterol (TC) and HDL cholesterol (HDL-C) concentrations, using a simple equation:

non-HDL-C = TC – HDL-C

The concentration expressed in mg/dl or mmol/l.

Does testing non-HDL-C have some advantages compared to LDL-C?

The concentration of non-HDL-C is considered as a useful parameter in assessing the risk of coronary heart disease, comparable to LDL-C. Adding non-HDL-C to the traditional lipid profile has many advantages:

Non-HDL-C is calculated from a simple equation, based on total cholesterol and HDL-C levels, thus its measurement is easily available even in small laboratories and doesn’t require additional costs.
It reflects cholesterol levels in all lipoprotein fractions that could increase risk for heart disease.
In contrast to LDL-C calculated from the Friedewald formula, non-HDL-C concentration is not associated with errors due to high triglycerides (e.g., in patients with diabetes and metabolic syndrome). Furthermore, it is possible to perform this test in patients who have not fasted.
Several population-based studies have shown a strong correlation between the concentration of non-HDL-C and apoliporotein B (apo B), a protein component of lipoproteins that increases CVD risk. If non-HDL-C is measured, there is no need to measure apo B.
Patients with elevated levels of non-HDL-C and yet normal levels of LDL-C often have an increased number of LDL particles, increased apo B or increased small, dense LDL particles and these are associated with an increased risk of CVD. Therefore non-HDL-C might be more valuable indicator of cardiovascular risk than LDL-C.

What treatments are recommended for high non-HDL-C levels?

Comparable to other lipid disorders, the first steps in the treatment of elevated levels of non-HDL-C are to lose weight, reduce calories in your diet, and substitute polyunsaturated fats for saturated fats. If these steps do not have the desired effects (i.e., lowering your non-HDL-C level and decreasing your heart disease risk), your healthcare practitioner may recommend that you start lipid-lowering therapy with statins.

View Sources

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(Nov 2013) American Heart Association. Understanding the New Prevention Guidelines. Available online at http://news.heart.org/aha-guidelines-resource-center/. Accessed May 2017.

(Jan 2013) National Heart, Lung and Blood Institute. Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Available online at http://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines. Accessed May 2017.

(November 2011) Saenger, A. Cardiovascular Risk Assessment Beyond LDL Cholesterol: Non-HDL Cholesterol, LDL Particle Number, and Apolipoprotein B. Mayo Clinic Communique. Available online at http://www.mayomedicallaboratories.com/articles/communique/2011/11.html. Accessed May 2017.

Virani S. Non-HDL Cholesterol as a Metric of Good Quality of Care Opportunities and Challenges. Tex Heart Inst J. 2011; 38(2): 160–162. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066801/. Accessed May 2017.

(May 2001) National Heart, Lung, and Blood Institute. ATP III Quic Reference Guide. Available online at https://www.nhlbi.nih.gov/health-pro/guidelines/current/cholesterol-guidelines/quick-desk-reference-html. Accessed May 2017.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Available online at https://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines/summary#chap9. Accessed May 2017.

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