nonHDLkolesterol

Non-HDL cholesterol is the concentration of all cholesterol carried by atherogenic lipoproteins. It is defined as total cholesterol minus HDL cholesterol. The non-HDL particle pool includes low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), lipoprotein remnants, and lipoprotein(a). Because these particles can deposit cholesterol in arterial walls, non-HDL cholesterol correlates with cardiovascular risk.

Non-HDL-C can be calculated from a standard lipid panel as non-HDL-C = total cholesterol – HDL-C, and is reported in mg/dL or mmol/L. Direct measurement methods exist for specialized testing. It remains a useful risk marker because it captures cholesterol carried by all atherogenic lipoproteins, not just LDL.

Clinical significance and guidelines emphasize non-HDL-C as a predictor of atherosclerotic cardiovascular disease, particularly when triglycerides are elevated or HDL is low. Many guidelines regard non-HDL-C as a practical target alongside or in place of LDL-C, especially in patients with metabolic syndrome or diabetes. Targets vary by guideline and risk category; a common approach is to aim for a non-HDL-C level consistent with reducing atherogenic particle burden, with guidelines often using about 30 mg/dL higher than the corresponding LDL-C goal, though exact targets depend on risk assessment.

Management focuses on lowering non-HDL-C through lipid-lowering therapies such as statins, with additional options including ezetimibe, PCSK9 inhibitors, and, in individuals with high triglycerides, fibrates or omega-3 fatty acids. Lifestyle measures—weight management, physical activity, and a diet low in saturated fat and refined carbohydrates—also contribute to reductions.