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Cardiovascular

Non-HDL cholesterol: calculation, targets and inherited high cholesterol

Lipoproteins are the particles that carry cholesterol through the blood, and the CVRM guideline calls the lipoproteins that carry the protein apoB the 'bad' ones. Non-HDL cholesterol measures the cholesterol in all those apoB-containing particles together.

According to Thuisarts, when cholesterol is too high for years the blood vessels can close up, usually slowly, which raises the risk of a heart attack and a stroke, among others. Only a blood test shows whether non-HDL cholesterol is high.

For people up to and including 70, the CVRM guideline links the targets for non-HDL cholesterol to those for LDL: an LDL of 1.8 mmol/l after a past cardiovascular disease and 2.6 mmol/l with another raised risk corresponds to a non-HDL of 2.6 and 3.4 mmol/l.

Doctor's Assessment Included

Non-HDL cholesterol is total cholesterol minus HDL cholesterol: the cholesterol in all the particles that can cause hardening of the arteries. Laboratories give no normal value for it; the Dutch CVRM guideline calls a non-fasting value above 3.9 mmol/l abnormal, and treatment targets are below 3.4 or below 2.6 mmol/l.

  • Non-HDL cholesterol can be measured without fasting and is calculated from an ordinary cholesterol test.
  • According to the Dutch cardiovascular risk guideline (CVRM), a non-HDL target below 2.6 mmol/l goes with an LDL cholesterol below 1.8 mmol/l after cardiovascular disease, and a target below 3.4 with an LDL below 2.6 at other raised risk; both apply up to and including age 70, and the guideline says targets should be used with some nuance.
  • Non-HDL cholesterol is one of the values in the SCORE2 table, which estimates the risk of cardiovascular disease.

When is this value abnormal?

Decision limits per result, in mmol/l
Result Value (mmol/l)
Normal < 3,9
Elevated ≥ 3,9

Non-HDL cholesterol is calculated as total cholesterol minus HDL cholesterol and adds up all the "bad" (atherogenic) cholesterol. Because fasting barely affects it, it can be measured in non-fasting blood. The limit of 3.9 mmol/l is the NHG guideline CVRM cut-off for non-fasting blood (80th percentile). Which value is desirable for you depends on your overall risk of cardiovascular disease: if there is a reason to treat, the NHG uses a lower target, < 3.4 mmol/l at high risk and < 2.6 mmol/l at very high risk (for example after cardiovascular disease). Discuss your result with your GP.

Source: NHG Reference population: Dutch adults (non-fasting, 80th percentile)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Non-HDL Cholesterol: what this test measures

Non-HDL cholesterol is total cholesterol minus HDL cholesterol in millimoles per litre (mmol/l), and no estimating formula is involved. According to the CVRM guideline, LDL cholesterol is usually calculated with the Friedewald formula, except when triglycerides are higher than 4.5 mmol/l or with dysbetalipoproteinaemia.

Non-HDL Cholesterol: why this value matters

A high non-HDL cholesterol can fit familial hypercholesterolaemia (FH), an inherited high cholesterol. According to the guideline on inherited dyslipidaemia, a physical examination then looks for tendon xanthomas: cholesterol deposits in tendons that the guideline calls characteristic of FH.

Non-HDL Cholesterol: how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Cardiovascular Health · €218,- · Metabolic Health Check · €129,- · Men Over 40 Panel · €279,- · Complete Men's Health Panel · €289,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Non-HDL Cholesterol: when is testing worthwhile?

According to the CVRM guideline, non-HDL cholesterol follows the effect of cholesterol-lowering treatment, with targets for people up to and including 70: after a past cardiovascular disease an LDL below 1.8 mmol/l, and with another raised risk an LDL below 2.6 mmol/l. According to the guideline, targets should be used with some nuance; a value just above the target can sometimes be accepted.

Non-HDL Cholesterol: symptoms of a high or low value

Low Levels

A low non-HDL cholesterol arises with a low total or LDL cholesterol. With a very low LDL cholesterol, below 0.5 to 1.3 mmol/l, the guideline on inherited dyslipidaemia advises genetic testing for hypobetalipoproteinaemia, an inherited low LDL.

High Levels

A high non-HDL cholesterol cannot be felt: according to Thuisarts, high cholesterol causes no symptoms and is not a disease. Cholesterol that stays too high for years raises the risk of a heart attack, a stroke, angina and peripheral artery disease, according to Thuisarts, although not everyone gets these diseases.

Non-HDL Cholesterol: causes of a low or high value

What lowers the value

  • Cholesterol-lowering medicines

    Cholesterol-lowering drugs such as statins lower non-HDL cholesterol; for prevention, the UK NICE guideline aims for a fall of more than 40 percent.

  • Acute illness

    Total cholesterol drops at the onset of an acute illness and returns to normal during recovery.

What raises the value

  • Inherited high cholesterol

    The most common inherited cause of high LDL cholesterol, and with it high non-HDL cholesterol, is the sum of many small gene variants; familial hypercholesterolaemia, caused by a single gene, affects about 1 in 250 people.

  • Underactive thyroid

    An underactive thyroid can raise LDL cholesterol, and with it non-HDL cholesterol, which includes LDL; the Dutch hereditary dyslipidaemia guideline therefore advises measuring TSH, among other tests.

  • Anabolic steroids or protein loss through the kidneys

    Anabolic steroids and a kidney disease with heavy protein loss in the urine (nephrotic syndrome) can raise LDL cholesterol, and with it non-HDL cholesterol.

  • Alcohol or poorly controlled diabetes

    According to the UK NICE guideline, heavy drinking and poorly controlled diabetes are possible causes of abnormal blood fats, non-HDL cholesterol among them.

  • Diet, weight and exercise

    An unhealthy diet high in saturated fat, being overweight and little exercise can raise cholesterol, and with it non-HDL cholesterol.

Non-HDL Cholesterol: lifestyle and this value

Many people with very high cholesterol in the family can point to inherited high cholesterol, according to Thuisarts, and a high non-HDL cholesterol, the cholesterol outside HDL, is then one to discuss with your GP.

Non-HDL Cholesterol: frequently asked questions

How much higher is non-HDL cholesterol than LDL cholesterol?

According to the CVRM guideline, in large studies of patients with or without cardiovascular disease, non-HDL cholesterol is on average 0.8 mmol/l higher than LDL cholesterol.

Is familial hypercholesterolaemia rare?

According to the guideline on inherited dyslipidaemia, heterozygous familial hypercholesterolaemia (FH) is one of the most common single-gene conditions, at 1 in 250 people.

Do the targets also apply above 70?

The LDL targets to which the CVRM guideline links the non-HDL targets, 1.8 mmol/l after a past cardiovascular disease and 2.6 mmol/l with another raised risk, apply to people up to and including age 70. The guideline describes the targets for people over 70 in a separate module, and it calls that age limit not an absolute limit.

Non-HDL Cholesterol: sources

  1. Nederlands Huisartsen Genootschap. NHG-Standaard Cardiovasculair risicomanagement. Praktische handleiding, 2024. Geraadpleegd 14 juli 2026. (retrieved 2026) richtlijnen.nhg.org
  2. NICE guideline NG238, Cardiovascular disease: risk assessment and reduction, including lipid modification, Recommendations, consulted 2026-10-06. (retrieved 2026) nice.org.uk
  3. Elmehdawi RR. Hypolipidemia: a word of caution. Libyan J Med 2008;3(2):84-90. (retrieved 2026) pmc.ncbi.nlm.nih.gov
  4. Richtlijn (Erfelijke) dyslipidemie in de 2e en 3e lijn, module Differentiaaldiagnose bij hypercholesterolemie, gepubliceerd 2018-04-03, geraadpleegd 2026-10-06 (retrieved 2026) richtlijnendatabase.nl
  5. Thuisarts.nl (NHG), Ik heb een hoog cholesterol, geraadpleegd 2026-10-16 (retrieved 2026) thuisarts.nl

Test Products

This marker is included in the following test panels.

Prostate

Men Over 40 Panel

Age-appropriate screening including testosterone and PSA.

HbA1c (Glycated Hemoglobin) PSA (Prostate-Specific Antigen) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€279,-
Testosterone

Complete Men's Health Panel

A broad men's health panel: hormones, heart, metabolic, and organ function in one blood draw.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Glucose (Fasting) Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone Ferritin hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€289,-

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
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