Why is my non-HDL cholesterol high?
Non-HDL cholesterol includes all cholesterol types except HDL and is a strong predictor of heart disease risk. High levels can result from diet, genetics, lifestyle factors, or underlying conditions, but can be effectively managed through dietary changes, exercise, and sometimes medication.
Jump To Section
Understanding Non-HDL Cholesterol
Non-HDL cholesterol represents all the cholesterol in your blood except for the 'good' HDL cholesterol. This measurement includes LDL cholesterol, VLDL cholesterol, intermediate-density lipoprotein (IDL), and other cholesterol-carrying particles that contribute to plaque buildup in your arteries. Many cardiologists now consider non-HDL cholesterol a better predictor of cardiovascular disease risk than LDL cholesterol alone, as it captures all potentially harmful cholesterol particles in one number.
Your non-HDL cholesterol is calculated by subtracting your HDL cholesterol from your total cholesterol. For example, if your total cholesterol is 220 mg/dL and your HDL is 50 mg/dL, your non-HDL cholesterol would be 170 mg/dL. The optimal level for non-HDL cholesterol is less than 130 mg/dL for most adults, though individuals with diabetes or existing heart disease should aim for levels below 100 mg/dL.
Understanding your complete cholesterol profile, including non-HDL cholesterol, provides crucial insights into your cardiovascular health. Regular monitoring through comprehensive testing can help you track your progress and make informed decisions about your health.
Non-HDL Cholesterol Level Categories
| Non-HDL Level (mg/dL) | Category | Risk Level | Recommended Action | |
|---|---|---|---|---|
| Less than 130 | <130 mg/dL | Optimal | Low risk | Maintain healthy lifestyle |
| 130-159 | 130-159 mg/dL | Above optimal | Moderate risk | Lifestyle modifications recommended |
| 160-189 | 160-189 mg/dL | Borderline high | Increased risk | Intensive lifestyle changes, consider medication |
| 190-219 | 190-219 mg/dL | High | High risk | Medication likely needed with lifestyle changes |
| 220 or higher | ≥220 mg/dL | Very high | Very high risk | Immediate medical intervention required |
Target levels may be lower for individuals with diabetes or existing cardiovascular disease.
Normal vs. High Non-HDL Cholesterol Levels
Non-HDL cholesterol levels are categorized based on cardiovascular risk. Understanding where your levels fall can help you and your healthcare provider determine the best course of action for your heart health.
These target levels may be adjusted based on your individual risk factors. People with diabetes, a history of heart disease, or multiple cardiovascular risk factors typically need to maintain lower non-HDL cholesterol levels. Your healthcare provider can help determine your specific target based on your overall health profile and risk assessment.
Common Causes of High Non-HDL Cholesterol
Dietary Factors
Your diet plays a significant role in determining your non-HDL cholesterol levels. Consuming high amounts of saturated fats found in red meat, full-fat dairy products, and tropical oils like coconut and palm oil can raise your cholesterol levels. Trans fats, although largely eliminated from the food supply, can still be found in some processed foods and significantly increase non-HDL cholesterol while lowering beneficial HDL cholesterol.
Additionally, excessive intake of refined carbohydrates and added sugars can increase triglyceride production in the liver, contributing to higher VLDL cholesterol and overall non-HDL cholesterol levels. Foods high in dietary cholesterol, such as egg yolks and organ meats, may also contribute to elevated levels in some individuals, though the impact varies based on genetic factors.
Genetic and Family History
Genetics play a crucial role in cholesterol metabolism. Familial hypercholesterolemia (FH) is an inherited condition affecting about 1 in 250 people, causing very high LDL and non-HDL cholesterol levels from birth. Even without FH, genetic variations can affect how your body produces, processes, and removes cholesterol from the bloodstream.
If you have family members with high cholesterol or early heart disease (before age 55 in men or 65 in women), you may have inherited genes that predispose you to elevated non-HDL cholesterol. These genetic factors can make dietary and lifestyle modifications less effective, often requiring medication to achieve healthy cholesterol levels.
Lifestyle and Environmental Factors
Several lifestyle factors contribute to elevated non-HDL cholesterol. Physical inactivity reduces your body's ability to clear triglycerides and VLDL particles from the bloodstream while also lowering beneficial HDL cholesterol. Smoking damages blood vessel walls and accelerates plaque formation while reducing HDL cholesterol levels. Excessive alcohol consumption can increase triglyceride production in the liver, raising VLDL and non-HDL cholesterol.
Being overweight or obese, particularly carrying excess weight around the midsection, is associated with higher triglycerides, lower HDL cholesterol, and increased non-HDL cholesterol. Even modest weight loss of 5-10% of body weight can significantly improve cholesterol levels.
Medical Conditions That Raise Non-HDL Cholesterol
Several medical conditions can contribute to elevated non-HDL cholesterol levels. Understanding these connections is important for comprehensive management of your cholesterol and overall health.
- Diabetes and insulin resistance: Poor blood sugar control increases triglyceride production and VLDL cholesterol while often lowering HDL cholesterol
- Hypothyroidism: An underactive thyroid slows metabolism and reduces the liver's ability to clear cholesterol from the blood
- Chronic kidney disease: Impaired kidney function affects lipid metabolism and can lead to elevated triglycerides and non-HDL cholesterol
- Liver disease: The liver produces and clears cholesterol, so liver dysfunction can disrupt normal cholesterol balance
- Polycystic ovary syndrome (PCOS): This hormonal disorder often causes insulin resistance and abnormal lipid profiles
- Cushing's syndrome: Excess cortisol production affects fat distribution and cholesterol metabolism
Certain medications can also raise non-HDL cholesterol as a side effect. These include some diuretics, beta-blockers, corticosteroids, immunosuppressants, and certain HIV medications. If you're taking any of these medications and have high non-HDL cholesterol, discuss alternatives with your healthcare provider rather than stopping medication on your own.
Upload your blood test results to track your progress
Seamlessly upload 3rd party biomarker & blood tests to track your whole health in 1 dashboard. Understand what each blood test means and how it fits into the bigger picture of your body and health.
Get diet and lifestyle recommendations based on your blood results, health profile and health goals. You'll also receive a custom supplement recommendation for the precise nutrients your body craves.
Upload Past Blood Test Results
Click or drag file to upload
Once you upload your report, we'll extract the results for your review. Works with top labs including Quest Diagnostics, LabCorp, BioReference, EverlyWell, LetsGetChecked and hundreds of other labs.
Health Risks of Elevated Non-HDL Cholesterol
High non-HDL cholesterol significantly increases your risk of atherosclerosis, the buildup of plaque in your arteries. This process narrows and hardens arteries throughout your body, reducing blood flow and oxygen delivery to vital organs. Over time, this can lead to serious cardiovascular events including heart attacks, strokes, and peripheral artery disease.
Research shows that for every 1% reduction in non-HDL cholesterol, there's approximately a 1% reduction in cardiovascular event risk. The relationship between non-HDL cholesterol and heart disease risk is linear and continuous, meaning even small reductions can provide meaningful benefits. Studies have also found that non-HDL cholesterol is a better predictor of cardiovascular risk than LDL cholesterol alone, particularly in people with diabetes, metabolic syndrome, or high triglycerides.
Beyond cardiovascular disease, elevated non-HDL cholesterol has been associated with increased risk of fatty liver disease, gallstones, and certain types of dementia. The systemic inflammation and oxidative stress associated with high cholesterol levels can affect multiple organ systems throughout the body.
Testing and Monitoring Your Cholesterol
Regular cholesterol testing is essential for understanding your cardiovascular risk and tracking the effectiveness of any interventions. A standard lipid panel measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, from which non-HDL cholesterol can be calculated. For the most accurate results, you typically need to fast for 9-12 hours before testing, though non-fasting tests are becoming more common.
Adults should have their cholesterol checked at least every 4-6 years, starting at age 20. However, more frequent testing is recommended if you have risk factors for heart disease, a family history of high cholesterol, or are making lifestyle changes or taking medications to manage your levels. Advanced testing that includes apolipoprotein B (ApoB) and lipoprotein(a) can provide additional insights into your cardiovascular risk profile.
If you already have recent blood test results, you can get a comprehensive analysis of your cholesterol levels and personalized recommendations through SiPhox Health's free upload service. This service provides clear explanations of your results and actionable steps to improve your cardiovascular health.
Dietary Strategies to Lower Non-HDL Cholesterol
Making strategic dietary changes can significantly reduce your non-HDL cholesterol levels. The most effective approach combines reducing harmful fats while increasing foods that actively help lower cholesterol.
Focus on incorporating more soluble fiber from sources like oats, barley, beans, lentils, apples, and psyllium. Soluble fiber binds to cholesterol in your digestive system and helps remove it from your body. Aim for at least 5-10 grams of soluble fiber daily. Plant sterols and stanols, found in fortified foods or supplements, can also block cholesterol absorption and lower non-HDL cholesterol by up to 10%.
Replace saturated fats with unsaturated fats from sources like olive oil, avocados, nuts, and fatty fish. Omega-3 fatty acids from fish like salmon, mackerel, and sardines can lower triglycerides and VLDL cholesterol. Consider following a Mediterranean-style diet, which emphasizes whole grains, fruits, vegetables, legumes, nuts, and olive oil while limiting red meat and processed foods.
Exercise and Lifestyle Modifications
Regular physical activity is one of the most effective ways to improve your cholesterol profile. Aerobic exercise helps lower triglycerides and VLDL cholesterol while raising beneficial HDL cholesterol. Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise weekly. Activities like brisk walking, jogging, cycling, swimming, or dancing can all be effective.
Resistance training also plays a role in cholesterol management by improving insulin sensitivity and body composition. Include strength training exercises at least twice weekly, targeting all major muscle groups. Even modest increases in physical activity can lead to improvements in non-HDL cholesterol levels.
- Quit smoking: Smoking cessation can improve HDL cholesterol levels within weeks and reduce overall cardiovascular risk
- Limit alcohol: If you drink, do so in moderation (up to one drink daily for women, two for men)
- Manage stress: Chronic stress can negatively impact cholesterol levels through both physiological and behavioral pathways
- Prioritize sleep: Aim for 7-9 hours of quality sleep nightly to support healthy metabolism
- Maintain a healthy weight: Even modest weight loss can improve cholesterol levels significantly
When to Consider Medication
While lifestyle modifications are the foundation of cholesterol management, medication may be necessary when non-HDL cholesterol remains elevated despite your best efforts. Your healthcare provider will consider your overall cardiovascular risk, including factors like age, blood pressure, smoking status, and family history, when determining if medication is appropriate.
Statins are typically the first-line medication for lowering non-HDL cholesterol, reducing levels by 30-50% on average. Other options include ezetimibe (which blocks cholesterol absorption), PCSK9 inhibitors (powerful injectable medications for severe cases), bile acid sequestrants, and fibrates (particularly effective for high triglycerides). Some people benefit from combination therapy using multiple medications to achieve target levels.
The decision to start medication should be made in consultation with your healthcare provider, considering both the benefits and potential side effects. Regular monitoring is important to ensure the medication is working effectively and to watch for any adverse effects. Many people can eventually reduce or eliminate cholesterol medications through sustained lifestyle changes, though those with genetic conditions may need long-term treatment.
Taking Control of Your Cholesterol Health
Managing high non-HDL cholesterol requires a comprehensive approach that addresses diet, exercise, and lifestyle factors while monitoring your progress through regular testing. Start by understanding your current levels and risk factors, then work with your healthcare team to develop a personalized plan that fits your lifestyle and health goals.
Remember that lowering non-HDL cholesterol is a gradual process. Most dietary and lifestyle interventions take 6-12 weeks to show their full effect on cholesterol levels. Be patient and consistent with your efforts, celebrating small improvements along the way. Even modest reductions in non-HDL cholesterol can significantly reduce your cardiovascular risk over time.
Stay informed about your cholesterol levels through regular testing and track your progress over time. Consider using tools and services that help you understand your results and provide personalized recommendations. With the right knowledge, support, and commitment, you can successfully manage your non-HDL cholesterol and protect your long-term cardiovascular health.
References
- Brunner FJ, Waldeyer C, Ojeda F, et al. Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium. Lancet. 2019;394(10215):2173-2183.[PubMed][DOI]
- Carr SS, Hooper AJ, Sullivan DR, Burnett JR. Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment. Pathology. 2019;51(2):148-154.[PubMed][DOI]
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143.[PubMed][DOI]
- Langlois MR, Nordestgaard BG, Langsted A, et al. Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM. Clin Chem Lab Med. 2020;58(4):496-517.[PubMed][DOI]
- Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. Eur Heart J. 2017;38(32):2459-2472.[PubMed][DOI]
- Sniderman AD, Thanassoulis G, Glavinovic T, et al. Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiol. 2019;4(12):1287-1295.[PubMed][DOI]
Was this article helpful?
Frequently Asked Questions
How can I test my non-HDL cholesterol at home?
What's the difference between non-HDL cholesterol and LDL cholesterol?
How quickly can I lower my non-HDL cholesterol?
Can I have high non-HDL cholesterol even if my LDL is normal?
What foods should I avoid if my non-HDL cholesterol is high?
This article is licensed under CC BY 4.0. You are free to share and adapt this material with attribution.
