Non-HDL cholesterol - a marker for cardiovascular risk

We think you'll be hearing more about non-HDL cholesterol - now included in all our cholesterol checks and health screens.

We’re delighted to announce that we report non-HDL cholesterol in all of our cholesterol tests and health checks that contain a lipid profile.

So what is non-HDL cholesterol and why does it matter?

Non-HDL cholesterol is exactly what it sounds like – it is a measure of all the cholesterol in your blood which is not high-density lipoprotein (i.e. good) cholesterol. You can take from this that what is left is actually the bad stuff, the cholesterol that has the capacity to create the plaques in your arteries that can eventually rupture and cause a heart attack.

Most people will recognise the blood fats that go to make up their lipid profile.

Typically, we measure:

  • Triglycerides – which are large fatty particles;
  • LDL cholesterol– the cholesterol carried through your blood by low-density lipoproteins (which is directly involved in atherosclerosis – the furring up of the arteries); and
  • HDL cholesterol – the cholesterol removed from the arteries and the plaques in the artery walls by high-density lipoproteins (which is why it is considered protective).

Traditional advice has focused on total cholesterol and LDL cholesterol with an emphasis on keeping total cholesterol under 5 mmol/L and LDL cholesterol under 3 mmol/L. The problem with this approach is that it doesn’t account for ALL the lipoproteins that are potentially harmful and cause the clogging up of our arteries. These are lipoproteins like VLDL cholesterol (very low-density lipoproteins) and small dense LDL particles which are known to be risk factors for heart disease but are not included in LDL cholesterol and are not broken down separately in a standard lipid panel.

By measuring non-HDL cholesterol, all the potentially damaging cholesterol is included which can give a better indication of cardiovascular risk than focusing on LDL cholesterol alone.

“Non–HDL cholesterol has been used in secondary prevention for some years, especially in the management of statins where we aim to see a 40% reduction in non-HDL cholesterol during treatment. Its use in primary prevention looks really promising and can help us identify people at higher risk of cardiovascular disease who may have been missed by conventional measures.”Dr Sam Rodgers.

What is a good number for non-HDL cholesterol, and what can you do if your level is elevated?

Heart UK recommends that your non-HDL cholesterol should be under 4 mmol/L and our laboratory specifies under 3.9 mmol/L. Your doctor may want you to be even lower than this, especially if you have other risk factors for heart disease.

The first steps to lower your non-HDL cholesterol are usually lifestyle-related: losing weight (especially if you are obese), eating less (especially less saturated fat and trans fats), exercising more, and, if you are diabetic or pre-diabetic, aiming to cut down on sugar and high glycaemic carbohydrates (carbohydrates which turn to glucose very quickly in your bloodstream).

For those at higher risk, or where lifestyle changes have made little difference, your doctor may want to consider cholesterol-lowering medications such as statins which are proven to be very effective in lowering non-HDL cholesterol and lowering your risk of a heart attack.

Non-HDL is easy to calculate, doesn’t need to be done on a fasting sample, and looks to be a better indicator of cardiovascular risk than LDL cholesterol alone. We think you’ll be hearing more about non-HDL cholesterol in the future!