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Heart and vessels · Blood
Non-HDL cholesterol
Total cholesterol minus HDL: the cholesterol in all harmful particles, used in the GP's SCORE2 risk chart.
At a glance
- Measured in blood
- In 3 test panels
- No special preparation
Explanation
Non-HDL cholesterol: what is measured?
Non-HDL cholesterol is calculated by subtracting the HDL cholesterol from the total cholesterol; both are measured separately. What remains is the cholesterol in all particles that can cause hardening of the arteries (atherosclerosis): LDL, VLDL, IDL and lipoprotein(a). That is why non-HDL gives a more complete picture than LDL alone, especially with high triglycerides. The Dutch GP guideline (NHG) uses non-HDL to estimate the ten-year risk of cardiovascular disease in the SCORE2 chart.
What can it detect?
- Increased risk of cardiovascular disease due to a lot of cholesterol in harmful particles
- Risk that is underestimated by LDL cholesterol, for example with high triglycerides, overweight or diabetes
- Effect of cholesterol-lowering treatment
Result
What does the result mean?
Non-HDL cholesterol too high
A raised non-HDL cholesterol means a lot of cholesterol in the harmful particles and fits a higher risk of hardening of the arteries, a heart attack and a stroke. How much a high value weighs depends on age, sex, smoking and blood pressure; together with non-HDL, these determine the risk in the SCORE2 chart. Causes are the same as for a high LDL and high triglycerides: predisposition, diet, overweight, diabetes, an underactive thyroid, kidney disease and some medicines. A high value does not cause symptoms.
Non-HDL cholesterol too low
A low non-HDL cholesterol is favorable and fits predisposition, a healthy lifestyle or cholesterol-lowering medicines. An unexpectedly low or falling value can go with an acute illness, an overactive thyroid, malnutrition or severe liver disease. A low value does not cause symptoms.
After an abnormal result
With a raised non-HDL, the GP estimates the ten-year risk with SCORE2 and discusses lifestyle; with a high risk, a repeat measurement, additional tests (glucose, kidney function, thyroid if needed) and possibly a statin usually follow. With strongly raised values, the GP considers inherited high cholesterol.
Reliability
How reliable is the test?
Non-HDL is a risk marker: a value calculated from total cholesterol and HDL that the Dutch GP guideline (NHG) on cardiovascular risk management uses as input for the SCORE2 risk estimate, together with age, sex, smoking and blood pressure. A single value is not a diagnosis; the same number can mean a low risk in one person and a high risk in another. According to the multidisciplinary guideline, non-HDL predicts the risk at least as well as LDL, and during treatment an LDL target of 2.6 or 1.8 mmol/l corresponds to a non-HDL of 3.4 or 2.6 mmol/l.
What can affect the result?
- Anything that affects total cholesterol or HDL carries through to non-HDL: pregnancy, an underactive thyroid, kidney disease, alcohol and medicines such as corticosteroids and cholesterol-lowering drugs.
- During and for a few weeks after an acute illness, surgery or heart attack, the value is temporarily lower.
- The SCORE2 chart is only intended for people aged 40 to 80 without cardiovascular disease, diabetes, moderate or severe kidney damage or inherited high cholesterol; for those groups, the GP determines the risk in a different way.
- The value fluctuates from day to day; with a result close to a treatment threshold, a repeat measurement is useful.
Who it is for
Who is the test useful for?
Useful for
Useful as part of the lipid profile for a cardiovascular risk estimate (the SCORE2 chart applies from 40 to 80 years), with smoking, high blood pressure, overweight, diabetes or kidney damage, with cardiovascular disease or strongly raised cholesterol in the family, and for monitoring cholesterol-lowering medicines. Also useful with high triglycerides, because LDL is then less reliable. For young, healthy adults without risk factors, repeated measurement is not needed.
How common is it?
There are no separate Dutch figures for a raised non-HDL cholesterol; it largely goes together with a raised total and LDL cholesterol. In 2024, more than 1.6 million people in the Netherlands were known to their GP with a lipid metabolism disorder, including high cholesterol; that is about 9 in 100 inhabitants.
VZinfo (RIVM) based on NIVEL primary care registrations, 2024
Drawbacks and risks
- In people with a low risk, a slightly raised value can wrongly be seen as a reason for concern or medicines; the guideline links treatment to the total risk, not to the single value.
Get tested
Non-HDL cholesterol: test panels
Non-HDL cholesterol is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
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Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and resultsMore explanations
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