Who is this especially useful for?
- ✓People with elevated triglycerides (>150 mg/dL)
- ✓Those with type 2 diabetes or prediabetes
- ✓Anyone with metabolic syndrome
- ✓Those with family history of heart disease
- ✓People whose LDL is at goal but still have cardiovascular risk
- ✓Anyone following a ketogenic or low-carb diet
Non-HDL captures ALL atherogenic particles — everything LDL misses.
What is Non-HDL Cholesterol?
Non-HDL cholesterol is calculated by subtracting your HDL ("good") cholesterol from your total cholesterol. The result represents ALL atherogenic (artery-clogging) lipoproteins in your blood — including LDL, VLDL, IDL, lipoprotein(a), and remnant particles.
Many cardiovascular researchers consider Non-HDL a superior predictor of heart disease risk compared to LDL alone. The 2018 ACC/AHA guidelines emphasize non-HDL cholesterol, especially for patients with elevated triglycerides, diabetes, or metabolic syndrome.
Example Calculation
200
Total Cholesterol (mg/dL)
55
HDL Cholesterol (mg/dL)
145 mg/dL
200 − 55 = 145 mg/dL — This includes ALL atherogenic particles (LDL + VLDL + remnants).
More Complete Than LDL
LDL-C misses VLDL, IDL, Lp(a), and remnant cholesterol. Non-HDL includes everything that can deposit in artery walls. This is why it's becoming the preferred marker in modern cardiology.
Why Non-HDL Matters More Than LDL
- Captures ALL atherogenic particles: LDL-C misses VLDL, IDL, Lp(a), and remnant cholesterol. Non-HDL includes everything that can deposit in artery walls
- No fasting required: Non-HDL is accurate whether or not you've fasted. LDL calculated by Friedewald equation becomes inaccurate with high triglycerides
- Better for metabolic syndrome: In patients with high triglycerides (common in insulin resistance), LDL underestimates true atherogenic burden. Non-HDL doesn't
- Validated in major outcomes trials: The Framingham Heart Study and multiple statin trials show Non-HDL predicts cardiovascular events better than LDL-C
Uses values from any standard lipid panel.
Three Perspectives on Non-HDL
Different health paradigms interpret Non-HDL thresholds differently:
Non-HDL Interpretation by Paradigm
Standard Medical
Research Consensus
Metabolic Optimization
Standard Medical
ATP III/ACC guidelines. Non-HDL targets are LDL goal + 30 mg/dL.
< 130 mg/dL for most adults; < 100 mg/dL for high-risk patients.
Research Consensus
Preventive cardiology outcome studies. Lower is generally better.
Target < 100 mg/dL; < 70 mg/dL for primary prevention in some studies.
Metabolic Optimization
Low-carb/ketogenic context. LDL may rise but VLDL drops.
Stable/improving Non-HDL with excellent TG/HDL suggests good adaptation.
How to Test
💡 Pro tip: Non-HDL is automatically calculated if you have total cholesterol and HDL. No separate test needed.
How to Lower Non-HDL Cholesterol
Since Non-HDL captures multiple lipoprotein types, improvement strategies are multifaceted:
Lower Triglycerides
Reduce refined carbohydrates
Major driver of VLDL production
Limit sugar and fructose
Directly raise triglycerides
Consider omega-3s
Fish oil significantly lowers TG
Limit alcohol
Significant impact on triglycerides
Dietary Patterns
Mediterranean diet
Proven cardiovascular benefits
Low-carbohydrate diets
Particularly effective for high TG
Reduce processed foods
Improve overall lipid profile
Lifestyle & Medical
Regular exercise
Lowers TG, raises HDL
Weight management
Reduces VLDL production
Address insulin resistance
Root cause of VLDL overproduction
For Keto/Low-Carb Dieters
Keto dieters may see LDL rise, causing concern. Non-HDL provides context — if triglycerides drop significantly, the rise in LDL may be offset by lower VLDL, keeping Non-HDL stable or improved. Track both TG/HDL ratio and Non-HDL for the complete picture.
Frequently Asked Questions
Key Takeaways
- 1Non-HDL = Total Cholesterol − HDL Cholesterol
- 2Captures **ALL atherogenic particles** (LDL + VLDL + IDL + Lp(a) + remnants)
- 3Superior to LDL alone for cardiovascular risk prediction
- 4**No fasting required** — accurate in fed state
- 5Target below 130 mg/dL for most adults; below 100 mg/dL for high-risk
- 6Particularly valuable when triglycerides are elevated (LDL becomes inaccurate)