Recently, non-HDL cholesterol (non-HDL-C) has become a commonly used marker for a blood lipid pattern associated with increased risk of heart disease.
To calculate non-HDL-C, you only need to know the numbers for total cholesterol and high-density lipoprotein cholesterol (HDL-C).
But why is non-HDL-C such a useful measure of future risk?
Atherosclerosis is the most common underlying cause of cardiovascular disease. It is due by a complex interplay between lipoproteins, white blood cells (macrophages), the immune system and the natural elements of the arterial wall.
Lipoproteins are the particles that transport cholesterol and triglycerides in the blood stream.
Lipoproteins that are directly involved in atherosclerosis are termed atherogenic. Most of these lipoproteins carry cholesterol and other types of fats such as triglycerides.
A standard lipid profile measures total cholesterol, triglycerides, and HDL-C.
These numbers are then used to calculate low-density lipoprotein cholesterol (LDL-C), according to the so-called Friedwald equation. However, calculation of LDL-C has several limitations.
Limitations of LDL Cholesterol
For historical reasons, LDL-C has become a primary goal of therapy in cardiovascular prevention. Recommendations regarding diet and drug therapy to lower cholesterol are most often based on the LDL-C number.
However, LDL is not the only lipoprotein involved in atherosclerotic heart disease. Triglyceride-rich very low-density lipoprotein (VLDL) and the so-called remnant lipoproteins are also atherogenic.
Therefore, there is a need for a lipid parameter that better reflects the amount of cholesterol within all atherogenic particles. This is of particular importance when triglyceride levels are high which is quite common, for example among people with abdominal obesity or metabolic syndrome.
What Is Non-HDL Cholesterol and Why Is It Important?
HDL and LDL particles seem to play very different roles in the pathogenesis of atherosclerosis. Therefore, measuring the amount of cholesterol within these particles tells two different stories.
While high levels of LDL-C are associated with increased risk of heart disease, elevated levels of HDL-C are associated with lower risk. HDL particles appear to be involved in clearing and removing cholesterol from arteries and atherosclerotic plaques while LDL-particles seem to participate directly in the atherosclerotic process itself.
This is the reason the cholesterol carried by HDL particles (HDL-C) is often called “good cholesterol” and the cholesterol carried by LDL particles (LDL-C) is called “bad cholesterol.” Of course, it is the same cholesterol; the difference lies within the lipoproteins that carry it.
Measuring total cholesterol provides limited information about risk because the number includes both HDL-C and LDL-C.
If we, however, subtract HDL-C from the total cholesterol we will have a measure of the amount of cholesterol carried by all lipoproteins except HDL. Doing this simple math will give us the amount of cholesterol carried within all lipoproteins that are atherogenic. In other words; a measure of cholesterol carried within all the “bad” lipoproteins but not the “good” ones (which is only HDL). This measure is termed non-HDL cholesterol (non-HDL-C).
Relying on LDL-C alone may be misleading. For example, individuals with abdominal obesity, metabolic syndrome or diabetic lipid disorders often have elevated triglycerides, low HDL-C, and relatively normal calculated LDL-C. Despite their normal LDL-C, these patients produce highly atherogenic lipoproteins such as VLDL and IDL (intermediate density lipoprotein) as well as small dense LDL particles.
A patient with low LDL-C and high non-HDL-C is an example of a patient with increased risk who may slip through the cracks because we only look at LDL-C. These patients are also likely to have high LDL particle number (LDL-P) as well as high ApoB levels.
Recent evidence suggests that non-HDL-C shows a better correlation with small dense LDL particles than do other lipid parameters including LDL-C. Clinical studies strongly suggest that a predominance of small dense LDL-C is associated with increased risk of coronary heart disease.
Non-HDL-C has been shown to be a better marker of risk in both primary and secondary prevention studies. An analysis of data combined from 68 studies, non-HDL-C was the best risk predictor of all cholesterol measures, both for CAD events and for strokes.
How to Calculate Non-HDL Cholesterol
An advantage of using non-HDL-C is that you don’t need a fasting blood sample.
Non-HDL cholesterol is your total cholesterol minus your HDL cholesterol
This is the formula:
Non-HDL Cholesterol = Total Cholesterol – HDL cholesterol
So if your Total Cholesterol is 220 mg/dL (5.7 mmol/L) and your HDL cholesterol is 50 mg/dL (1.3 mmol/L);
Non-HDL Cholesterol is 170 mg/dL (4.4 mmol/L)
If you know this simple formula, your knowledge outperforms 44 percent of providers in medical practice in the US. A survey showed that 44 percent of providers in practice could not calculate non-HDL-C when provided a standard lipid profile. Interestingly, cardiologists were just as likely as primary care physicians not to understand the calculation.
What Is a Desirable Level of Non-HDL Cholesterol?
The treatment goal for non-HDL-C is usually 30 mg/dL above the LDL-C treatment target. For example, if the LDL-C treatment goal is <70 mg/dL, the non-HDL-C treatment target would be <100 mg/dL.
Here you can see how non-HDL-C levels are looked at in terms of risk:
- above 220 mg/dL (5.7 mmol/L) is considered very high
- 190 – 219 mg/dL (4.9 – 5.6 mmol/L) is considered high
- 160– 189 mg/dL (4.1 – 4.8 mmol/L) is considered borderline high
- 130 – 159 mg/dL (3.4 – 4.0 mmol/L) is considered near ideal
- below 130 mg/dL (below 3.4 mmol/L) is considered ideal for people at risk of heart disease
- below 100 mg/dL (below 2.6 mmol/L) is considered ideal for people at very high risk of heart disease
How To Lower Non-HDL Cholesterol
Lowering non-HDL-C always begins with lifestyle therapy, usually aimed at lowering triglycerides. Traditionally, reduction in total calories, especially saturated and trans fatty acids, in combination with exercise is recommended. However, reducing sugar and carbohydrate consumption is often very effective in lowering triglycerides and non-HDL-C, particularly in patients with abdominal obesity or the metabolic syndrome
Foods that are high in omega-3 fatty acids may also be useful. Fatty fish such as salmon, sardines, mackerel, and herring is rich in omega-3. Omega-3 fatty acid-containing capsules or fish oils represent a reasonable alternative.
Moderate physical activity can help raise HDL-C and lower non-HDL-C.
Quitting smoking will improve your HDL-C and reduce non-HDL-C. Several studies have shown that male and female smokers have significantly lower HDL-C levels than non-smokers.
Successful reduction of elevated non-HDL-C may also be achieved with medical therapy. This would include the use of a statin drug to serve as the foundation for LDL-C lowering followed by a second treatment to bring non-HDL-C to within the target range. The three categories of drugs that would fall into this group include omega-3 fatty acid preparations, fibrates, and niacin.
However, there are very few clinical endpoint studies evaluating the potential benefit of combining each of these triglyceride lowering modalities with a statin as compared with a statin, making it very hard to recommend such a combination therapy.
Henry says
October 30, 2013 at 01:29These guidelines are out of date. Have you read up on the recent research in Cholesterol Clarity or Jimmy Bowden’s research on the Cholesterol Myth? Treat inflammation – not cholesterol is where the real focus should be. Thought?
Doc´s opinion says
October 30, 2013 at 08:42Henry. I’ve read Cholesterol Clarity and The Great Cholesterol Myth. Indeed I’ve written blog posts on both these books here and here.
I still believe that understanding your lipid profile is important. I would guess Moore and Bowden also agree on that. That’s probably why they wrote their books. Understanding Non-HDL cholesterol may help us understand the lipid profile of people with the metabolic syndrome. It highlights the fact that looking only at LDL-C has several limitations.
I have also recently written a blog post on Inflammation and Heart Disease. Although inflammation is important we can’t just ignore the role of lipids.
bhrdoc says
October 30, 2013 at 11:39Another excellent post Axel. In fact, as Cui showed in his article in the Archives of Internal Medicine (Cui, Y et al, Arch Int Med 2001;161:1413-19) LDL-C is the WEAKEST lipid predictor of CVD risk, with both elevated non-HDL-C and low HDL-C being far more predictive.
JanKnitz says
October 30, 2013 at 20:15Curious if the traditional lifestyle changes yielded the desired results, considering reduction of sat fat probably does not lower trigs, and people who reduce fat tend to eat more carbs which raise trigs?
Doc´s opinion says
October 30, 2013 at 20:18In most circumstances avoiding sugar and refined carbs will be more helpful than avoiding animal or dairy fats when it comes to lowering triglycerides, and thereby non-HDL-C.
turtlefoot says
September 21, 2016 at 21:57Have metabolic syndrome as well as a host of autoimmune disorders. But I also have somewhat enviable lab values and they are improving with a few strategic dietary tweaks:
Triglyceride.
154 mg/dL(0 – 149)
Cholesterol
203 mg/dL(112 – 199)
HDL 76 mg/dL(>=40 – )
LDL Calculated 96 mg/dL
Chol/HDL Ratio 2.7(0.0 – 4.5)
Non HDL Chol 127 mg/dL
So, yes, they are not ‘perfect’ but by focusing more on complex carbs and very little processed food, they’re getting better. I’ve actually acquired a distinct distaste for commercial baked goods (taste like chemicals to me) and prepared/canned food. Simple foods, well prepared with unrefined ingredients as much as reasonably possible, oilve oil when I do use oil, butter, NEVER margerine or hydrogenated veg shortening, and trying to stay gluten free (celiac disease) has all helped. Added a high-quality fish oil supplement a month before these labs were drawn. I avoid even commercially prepared gluten-free products also since they often create a high glycemic load. If I were physically able to be a lot more active, these would no doubt all be in excellent ranges, but oh well…happy to be where I am so far. Family history of CAD both parents and both siblings.
thehomeschoolingdoctor says
November 1, 2013 at 08:12Nice summary. Thank you.
Mike says
November 5, 2013 at 02:51Hi Doc,
I recently discovered your blog and find it very helpful. In June, 2013, my physician wanted to put me on statins based on a standard blood test. I asked for the more detailed particle size NMR LipoProfile. I would rather continue to manage my health through improved diet and exercise. Your advice would be very appreciated.
I am a 58 year old white male, 5’8″ tall. I am in good physical shape, exercise regularly, and have brought my weight down to 150 pounds. BP = 114/70. BMI = 23.36. Family history includes my (still going strong) 92 year old father who’s had heart issues. My mother passed away at 85 of a heart attack (& had age-onset diabetes).
Results of standard test (6/17/13):
HDL 47
Triglycerides 121
Trig/HDL Ratio 2.57
VLDL 24
LDL Overall 167
ALT 18
Glucose, Serum 93
Results of NMR (10/9/13):
LDL-P 2328
LDL-C 180
HDL-C 50
Triglycerides 82
Trig/HDL Ratio 1.64
Total Cholesterol 246
HDL-P 31.0
Small LDL-P 1177
LDL Particle Size 21.1
LP-IR 43
Thanks
Doc´s opinion says
November 13, 2013 at 16:34Mike. According to the most recent US guidelines on cardiovascular prevention assessing total risk is more important than lipid numbers when deciding whether or not to treat with statins. Both LDL-C and LDL-P are elevated in your case. However, in the absence of strong family history of cardiovascular disease, high blood pressure, diabetes an smoking it would be hard for me to advocate statin therapy in your case.
Dayana Wiggins says
April 3, 2018 at 17:59We could calculate this 10 year ASCVD risk in order to make a decision. The risk estimator is available online so any clinician can use! here is the link
http://www.acc.org/tools-and-practice-support/mobile-resources/features/2013-prevention-guidelines-ascvd-risk-estimator
S.Babeanu says
January 18, 2014 at 14:21Hello Doctor. Interesting data. I would like to get from you an advice:
I am female 75yrs old, ,BMI 30 Height 5″, exercise: walking 3-4 times a week 3km/day. Mild hypertension under Enalapril 20mg and Indapamide 1.5 mg is 130/84mmHg, with following blood tests:: TC 268, HDL-C 60,87, LDL-C 185,8, slightly increasing from the last to the present year TG 108, glycemia 86,59. Creatinine 1,25. I was advised to take statins at lower dose. Unfortunately the adverse effects were almost intolerable: muscular pain, important dizziness until vertigo irrespective of statin kind. I would highly appreciate if you could give me your opinion. Thank you very much for your understanding
Axel F Sigurdsson says
January 19, 2014 at 12:31With all those side effects you mention it’s obvious to me that taking statins will be very difficult for you. There’s no reason to believe that statin therapy will prolong your life more than improving your diet and lifestyle. So making your life miserable by statin treatment is not anything I would recommend. Try to look at other alternatives. You might want to improve your TG/HDL ratio and your non-HDL-cholesterol. Are you overweight? Do you exercise regularly. How about sugar? Can you cut down on refined sugars. If you’re overweight you might have insulin resistance. In that case losing weight is most often helpful.
SBabeanu says
January 19, 2014 at 20:48Thank you dr.Sigurdsson. The only thing I have to do is to lose weight. The rest I did except the exercise. I confess I am too lazy. Have a nice day
Ian Shaw says
May 19, 2014 at 09:42My wife has had a recent lipogram which shows TC = 6.6 mmol/L, S-LDL 4.2 mmol/L, S-HDL 1.9 mmol/L, S-Non-HDL 4.6 mmol/L.
In the remote past, she took 10mg dosage of statins, but had no side effects. She is 55 yrs old, glucose 5 mmol/L,
BMI = 30 (obese), eats no sugar, exercises seldom,eats moderate amounts of meat and cheese, lots of vegetables, some fruit only low GI wholewheat rolls and uses only canola or olive oil for cooking.
Would you recommend statin (available is quiet cheap generic simvastatin) ?
Axel F Sigurdsson says
May 19, 2014 at 20:00Assuming that family history is benign, she doesn’t smoke and blood pressure is normal, the only risk factor is a slightly elevated LDL-C. In that case my answer is no. I think there is very little to gain from statin treatment.
DR.NISHA LALWANI says
June 21, 2014 at 08:26VERY INFORMATIVE,I MUST SAY.
IS THERE ANY WHO GUIDELINES AVAILABLE FOR NON HDL -C IN GENERAL LIPID PROFILE AND THERE REF.RANGE ? DOES DIRECTLY MEASURED LDL-C IS ALSO HAVING SAME SIGNIFICANCE AS CALCULATED ONE?IF D-LDL-C MEASURED STILL WE NEED TO CALCULATE NON HDL-C.PLEASE ELOBORATE.
Kjell Granelli says
July 21, 2014 at 06:44Elevated non-HDL-C might be the result of high levels of the “large, fluffy” LDL particles, which are generally considered benign and non-atherogenic. For example, ketogenic diets seem to easily produce a profile with high total cholesterol, high HDL, low TG and high calculated LDL. When you look at the numbers of small dense vs large fluffy (we call that “Apo ratio” in Sweden), almost invariably this confirms the benign nature of LDL. So is not looking at non-HDL-C potentially misleading, as a high value might reflect a high level of the benign LDL? (Maybe as benign as HDL itself!)
Axel F Sigurdsson says
July 21, 2014 at 09:34Kjell.
I think you’re right. Non-HDL-C has its limitations although I believe it better reflects the concentration of atherogenic particles than does LDL-C. I agree with you that non HDL-C can’t differentiate between small and large particles. TG/HDL-C ratio on the other hand can to a certain degree reflect LDL-particle size and particle concentration. You can see a blog post I wrote on that here. I agree that Apo ratio provides additional information to the traditional lipid profile. Apo-B reflects particle number in a similar manner that LDL-P does.
Thanks for bringing this up.
Kjell Granelli says
July 21, 2014 at 20:24Axel,
Thanks for your reply. I have read that the TG/HDL ratio is a surrogate marker for oxidized LDL (which would be approximately the same as particle size) and insulin resistance. It would be very interesting to read the blog post you are referring to, but the link does not seem to work.
Axel F Sigurdsson says
July 22, 2014 at 09:49Sorry Kjell, Here is the link.
Mie says
July 22, 2014 at 20:50Kjell,
“Elevated non-HDL-C might be the result of high levels of the “large, fluffy” LDL particles, which are generally considered benign and non-atherogenic.”
No matter how many times this is repeated, it’s simply not true. ALL LDL particle subtypes are atherogenic in large quantities (as they can all penetrate the arterial wall) and the “special” status of sdLDL is attenuated more or less totally when controlling for particle number. Studies as EPIC and MESA have shown this.
Kjell Granelli says
July 23, 2014 at 12:17Mie,
However, I believe the small dense are cleared less effectively by the liver than the large bouyant, so they remain much longer in the bloodstream, which would in itself make them more atherogenic. Of course, controlling for this time lapse as a confounder would then, as you point out, potentially make them more equally atherogenic – but it would seem incorrect to control for such an important factor which may decide whether there is an atherogenic effect at all. / Kjell Granelli
Mie says
July 23, 2014 at 15:49Kjell,
“However, I believe the small dense are cleared less effectively by the liver than the large bouyant, so they remain much longer in the bloodstream, which would in itself make them more atherogenic.”
SdLDL has somewhat lower affinity for LDL receptors which means lower hepatic clearance. These findings, however, are attenuated after adjusting for particle numbers (just like you yourself mentioned).
And by no means does this mean that larger particles aren’t atherogenic! Every subclass can penerate the arterial wall, this has been demonstrated plenty of times.
The final part of your message was odd. Did you really mean that we shouldn’t control for LDL-P?
Kjell Granelli says
July 23, 2014 at 16:11Mie,
My final remark was not meant to suggest we do not measure the number of LDL particles. I simply suggest that if the larger LDL remain a shorter time in the bloodstream they are less atherogenic because of that. Therefore, a shift of LDL composition from more of the smaller to more of the larger would seem beneficial to lower CVD risk.
However, if the difference in rate of hepatic clearance is small, what I state above might be of small practical importance…. which is what I would like to understand 🙂
Mie says
July 23, 2014 at 17:52Ok. Although “less” is hardly a synonym for “non”, right? 🙂
Anyway, sdLDL (combined with high LDL-P) tends to be a problem for met.syndrome/DM2 patients and appears together with properly messed lipid etc. etc. values altogether. Shifts in particle size isn’t therefore a likely solution as such – lowering LDL (both C and P, perhaps especially the latter in population like this) is, as this can be accomplished via a variety of approaches. Particle size isn’t really an independent risk factor nor is there evidence that trying to modify it instead/in addition of e.g. LDL-P offers any benefits.
Claude M. McQuarrie III says
July 24, 2014 at 20:23On whether combination therapy should be considered, you might want to re-read the ANCHOR trial results. There, Icosapent ethyl (IPE, also called EPA, brand name Vascepa) was given with statins to patients with persistently high TGs (200-499 mg/dL) vs. statin plus placebo. IPE 4g/day lowered TG by 21.5%, non-HDL by 13.6%, LDL by 6.2%, VLDL by 24.4%, hs-CRP by 22%, Apo B by 9.3%, and Apo-C III by 19.2% (among others). The only side effect was arthralgia in about 1.5%. (All figures placebo adjusted.)
EPA increases EPA/AA ratio, reduces systemic inflammation, reduces oxidative stress and reverses endothelial dysfunction at the cellular level, significantly increases coronary fibroatheroma cap thickness (increasing plaque stability), all with essentially no side effects.
Compared to fenofibrates and niacin, whose challenging side effects are well known (and, in the case of niacin, unacceptable to most) EPA is a far superior drug. And, EPA does not raise LDL-C as does its cousin, Lovaza (which contains DHA).
Whether to wait for an outcomes trial result (REDUCE-IT, 2017) to prove EPA’s clinical efficacy is becoming more problematic for several reasons:
1. HTG subgroup analyses in 6/6 TG-lowering CVD outcome studies (JELIS, FIELD, ACCORD, AIM-HIGH, BIP, VA-HIT) involving varied populations and 3 different classes of medications all showed CVE reduction.
2. Meta-analytical data from 61 studies; 17,018 CVD deaths in 726,030 subjects; 58,419 all-cause deaths in 330,566 subjects showed “Elevated blood triglycerides were dose-dependently associated with greater risk of both CVD and all-cause mortality … [and] suggest that controlling triglycerides can help to prevent CVD and other causes of death … [with] each 1 mmol/L increase in triglycerides was associated with 13% increase in CVD mortality and 12% increase in all-cause mortality.” Liu, et al; Lipids Health Dis 2013; 12:159.
3. Genetic data is accumulating to suggest a causal relationship between elevated TGs and CVD. Do, et al; Nat Genet 2013 Oct 6; Eur Heart J 20143; 34: 1826-1833.
4. Very recently, two groups independently concluded that ApoC-III mutations resulted in lowered ApoC-III and about 40% lower TGs and about 40% fewer CVD events, again suggesting the possibility that HTG may play a causal role in CVD. NEJM, June 18, 2014 (e-pub).
As you will remember, statins were prescribed for several years to reduce CVD risk before outcomes studies proved clinical efficacy. There is, today, greater evidence of clinical efficacy for lowering HTGs than there was when statins were first prescribed.
Kofi Akomeah says
August 4, 2014 at 16:56I am a 40 year old male with elevated blood pressure. I am currently taking losarten (100mg) and have been on it for almost 4 years. My reading are always around 123-116/82-75. I have been persuading my doctor to take me off the dose as i exercise very regularly and eat very well. I am 6 foot and weigh 172 pounds. Recently i had my annual physical and based on my results he wants to start me on cholestoral lowering drug based on my LDL (saying it needs to be below 75) since I am a high risk due to my elevated blood pressure..See below my results for my annual physical…I do not smoke, never had a heart attack, and the only drinking i do, is a glass of red wine every night (Monday thru Friday)
TIME POST PRANDIAL, PATIENT 12
CHOLESTEROL 40 MG/DL 72
CHOLESTEROL, NON-HDL 110
TRIGLYCERIDE <150 MG/DL 77
LDL 95
I have told my doctor i am not going to be taking any drug for Cholestoral
Thanks
Mie says
August 4, 2014 at 17:55Claude,
“As you will remember, statins were prescribed for several years to reduce CVD risk before outcomes studies proved clinical efficacy. There is, today, greater evidence of clinical efficacy for lowering HTGs than there was when statins were first prescribed.”
You shouldn’t confuse the history of use of any given drug with proper criteria for clinical efficacy.
Jesse Lanou says
October 17, 2014 at 23:46My TSH, HDL and LDL levels were’t too bad until I started taking anastrozole at the beginning of the year. Does anastrozole cause these levels to go up (especially my TSH that went from 1.81 to 5.92 in less than a year)? I have an appointment with my medical oncologist next week to talk about this, but his initial response is that he doesn’t think the anastrozole is to blame. Nothing else changed this year. I eat the same, take the same supplements, but switched from Tamoxifen to anastrozole in January. Thoughts?
George says
November 7, 2014 at 00:40MOST of you never need to be on statins … this will change your life – IF YOU DO IT:
https://www.dresselstyn.com/site/
kathleen Vaughn says
November 26, 2014 at 04:16hi
I just read your article and I feel much better about my lipid panel #s.( see below) I was shocked to see my #s art first because i eat pretty good. a usual day is Fruit and plain greek yogurt for breafast. kale salad and a sweet potato or tomato soup and 1 slice whole wheat bread with peanut butter(natural type) and dinner is usually fish or chicken with veggies. Apple as a snack and iced coffee with 1/2 & 1/2 and 1packet sugar.
my cholesterol non hdl is pretty good so I am hopeful.
thanks
CHOLESTEROL 221
TRIGLYCERIDE 50
HDL 74
LDL CALCULATED 137
CHOLESTEROL/HIGH DENSITY LIPOPROTEIN 3.0
CHOLESTEROL, NON-HDL 147
eniedorf says
November 26, 2014 at 15:43Do you know anything about Hypercholesterolemia?
I have been on statins since I was 23. My father and brother have FH and both have had bypass this year. My father at 68, my brother at 44. I have recently found out both of my children, age 12 and 15 have total cholesterol levels around 300 and both are highly active in high cardio sports and we eat well, not perfect, but well. My total number is 310, with an HDL of 41, non-HDL of 269. I have been to the cardiologist and passed a stress test and show 6% calcification when I did a scan. I do not want bypass or have a major heart attack but I feel the odds are stacked against me. Symptoms for women differ so much from men. Is there something else I should be doing to help and what would be my course for my children
Maya says
December 5, 2014 at 19:09I have been a vegetarian for 35 years.I sparingly eat fish and seafood, mostly salmon and canned mackerel. For 16 months I have been fasting two days a week. My BMI is 21 and I exercise 2 or 3 times a week. My lunch is usually a veggie/fruit/protein shake with yogurt. My daily intake of food is small. Monthly junk food minimal. I do not drink sodas. Glucose level is normal and triglycerides are normal. However, my total cholesterol is now 314. Wow, I was amazed. Could this number be in any way related to my fasting for two days a week? Must I definitely go on statins as my doctor is recommending? Any good results with Red Rice Yeast? thanks.
Axel F Sigurdsson says
December 7, 2014 at 19:16Maya. My first impression is that your high cholesterol is genetic. I don’t think it’s related to your fasting or your lifestyle. Is there a family history of high cholesterol or other lipid abnormalities?
Maya says
December 8, 2014 at 00:01Thank you very much for your response. My mother passed away in her early 90s and father in his late 80s. Mother was on Lipitor but don’t know about my father. I do remember that about 25 years ago my level was 170 and fast forward to 5 years ago it was 240. So with age, it seems to be going up despite the vegetarianism, exercise, fasting, etc. With a genetic predisposition, is this what happens or should I have had genetically high blood pressure many years ago? Thank you again.
Penny says
December 7, 2014 at 23:36Hi,
I found this article very interesting. I researched it because I’m heading into my annual physical next week.
I have a history (since at least 1985) of high total cholesterol, low TG, high HDL and high LDL. (I understand that these numbers “interact” with each other.)
My recent lipid profile showed:
Cholesterol 275
Triglycerides 69
HDL 101
LDL 163
Chol/HDL 2.7
LDL/HDL 1.6
TG/HDL .68
Last year my numbers were even higher (317, 118, 100, 198 respectively) so I had a test done for Particle concentration and size.
HDL-P 44.4
SMALL LDL-P <90
LDL SIZE 22.2
LARGE VLDL-P 2.3
SMALL LDL-P 20.0
VLDL SIZE 47.3
LDL SIZE 22.0 (Pattern A)
HDL SIZE 10.1
LP-IR SCORE <25
LDL-P 1647
I'm 64, I take Phenobarbital for seizures and artificial thyroid meds for Hashimoto's Disease, plus a bunch of OTC supplements but other then then I feel really healthy. I exercise 3 to 4 days a week, however my diet is not great and I'm about 10 pounds overweight.
My parents both recently passed away at the age of 88 and 87, but their causes of death were not related to any heart issues and there is no history that I know of, with any other family member.
My doctor (general practitioner) and I have discussed Statins, but I am hesitant to go down that route. I've had a difficult time finding any information about individuals with my particular profile. I don't know if I should just be thrilled because my ratios look good or if I should be concerned because of the specific numbers. Given my history and the results of my particle size tests, I would greatly appreciate your input.
Thank you so much!
Penny
Axel F Sigurdsson says
December 8, 2014 at 11:09Penny
Despite your high total cholesterol there are a lots of positives regarding your risk profile. Of course I’m relying on that you don’t smoke.
Firstly, the fact that your parents lived to be this old is a very good sign in terms of risk.
The positive things about your lipid profile are the high HDL-C, the low TG’s, the low TG/HDL ratio, and the LDL-size (pattern A).
The decision on when to give statins and when not to is always difficult. It has to be a shared decision making between you and your physician. It also has to take into account other factors than the lipids themselves. Personally, if you are hesitant about statins I guess I would not try very much to convince you otherwise, unless there are some other risk factors that you haven’t mentioned.
j says
December 16, 2014 at 06:37My family all have the cholesterol problem even with regular exercise and very low fat diet. I had post polio and I was told that cholesterol medications will weaken my muscle. My grandfather had stroke. My father has angina. Both my parents almost 80 and still live independently.
My recent physical is total cholesterol :249
HDL: 50, Triglycerides:72, LDL-C:185,
Non-HDL-C: 199, C/HDLC Ratio:5. Glu:92.
Wt:124 Ht:5’2″.
I exercise 3X/wk and 2 hrs each time. I eat 80% of vegetables and 20% meat. No rice. I have fish 3X/wk. I use grape seed oil or walnut oil for cooking. I use less than 20 fl oz. Cooking oil a year. Any suggestions about lowing my Non-HDL-Cholestrol? I try to manage my cholesterol without taking medication.
Axel F Sigurdsson says
December 16, 2014 at 19:16Hi J.
It appears that you are doing the best you can in terms of diet and exercise.
With a family history of high cholesterol you may have a hard time lowering your Non-HDL cholesterol further without taking medication (I´m not suggesting you should, that’s something you’ll have to discuss with our doctor).
Charlie G. says
December 22, 2014 at 12:31Hello Dr., I have had chronic high lipids along with high Ferritin levels in the past and was wondering if you would suggest Prescription Medication for my scenario. I am 36, previously on low dose blood pressure medicine, chronic pain, several autoimmune issues, gout, and my grandfather had several heart issues:
Cholesterol-292
LDL-183
HDL-58
Tri’s-256
Non HDL-234
Glucose-99
I’m admittedly 20-30lbs over my typical weight, currently 6’1 235.
I have been able to correct the issues in the past to just slightly high levels with extremely strict diet and exercise and very limited alcohol use. This is a general life change and while it makes me feel better it also makes me feel a bit depressed.
I’ve never posted like this nor have I seen a specialist for these issues and hoping you can provide a little direction with the limited info you have here.
Axel F Sigurdsson says
December 22, 2014 at 22:29Hi Charlie G.
Your LDL-C and Non HDL-C are both a bit high and Triglycerides are way up. You should trie to lose weight. Carbohydrate restriction might help you lower your triglycerides. Sometimes high ferritin levels may be caused by haemochromatois. Have your doctor go over these things with you.
Lowering TG/HDL ratio may be a target.
I’m sorry, but I can’t give any individual recommendations regarding prescription therapy etc. You’ll have to discuss these things with your doctor. I can only provide general information and advice as in the article above.
ch says
December 22, 2014 at 17:09This will solve your problem. Take choleslo natural herbal supplement with no side effect. See how fast your level improve.I’m been using this product for a year now.
Clyde says
January 3, 2015 at 18:22I’m 77 years old and had a heart attack in 1986. I’m scheduled for knee arthroscopy Jan 9. My numbers seem acceptable to me except for non-HDL cholesterol. It is so far out of line I don’t know what to think.
Cholesterol 114
Triglycerides 72
HDL cholesterol 63
Chol/HDL ratio 1.8
Non-HDL Chol 51
Your take on this situation?
Axel F Sigurdsson says
January 3, 2015 at 19:08Hi Clyde
In fact your non-HDL cholesterol is ideal. Your total cholesterol and LDL cholesterol are both quite low as well. I assume your taking a statin drug. That could easily explain why your lipid profile looks this good.
Walter Rice says
January 14, 2015 at 23:12Dr.,
I am a 66 year old male and had a lipid panel run a month ago. My PCP wants me to go on a statin drug. I currently take no prescription drugs, good blood pressure, about 20 pounds overweight.
My lipid panel:
Total Cholesterol 114
Triglycerides 106
HDL 35
LDL 58
VLDL 21
T Chol/HDL 3.3
Non-HDL 79
My cholesterol has ranged from 90-114 my entire life, but over the past 20 years my HDL has ranged from 29-40.
Your take? Am I truly a candidate for taking statin drugs?
Axel F Sigurdsson says
January 15, 2015 at 07:39Hi Walter
Your lipid panel looks fairly good. Total cholesterol is quite low and so is LDL-cholesterol (within target range). HDL-cholesterol is a bit low. In my opinion it’s unusual to approach a lipid profile like this with a statin drug. Remember however that there may be other reasons for treating with statins such as known cardiovascular disease or diabetes.
Walter Rice says
January 15, 2015 at 21:17Dr,
Thanks. No diabetes or cardiovascular disease. Will diet changes (less dairy, sugar) and weight loss help raise HDL.? I am not a fan of taking statins or any prescription drug without justification.
fitness goals says
January 29, 2015 at 01:46I always spent my half an hour to read this web site’s
articles all the time along with a mug of coffee.
Kim Wagner says
February 14, 2015 at 22:39I’m a bit confused on my test results. I am 49, 5 f 4 in.,225 lb.female who does not smoke or drink. What do you make of my results?
Cholesterol Level 187 mg/dL
Jan 27, 2015 Triglycerides Level 279 mg/dL
Jan 27, 2015 HDL Cholesterol 66 mg/dL 40-60
Jan 27, 2015 LDL Cholesterol, Calculated 65 mg/dL
Joan says
February 16, 2015 at 02:08Dr,
Thanks in advance
First I am thankful to write to you because if I ” check with my Cardiologist – he is mainstream and doesn’t know much about F/H or high Cholesterole except – statins is his answer.
I began to believe my numbers were concerning when no one else with high numbers was in the 400’s like myself.
12/13 –T- 411 LDL 295 HDL 108 Try 50
LDL-P 2448 non HDL- 303 t/HDL 3.8
I cut out drinking raw milk , no coconut oil, much less butter and using only Olive oil
4/14. – T311 LDL 203 HDL 97. Try 55
LDL P 1933 non HDL 254 T/ HDL 3.2
I’ take EPA 1-2 gm /day
Acerola Vit c
Vit A&d3
Drink whey
And Tocotrienols
Amd Probiotics
My diet is clean , nothing processed, lots of greens, sourdough pancakes, lots of nuts , meat and fish , few eggs and avacados. Apples and dates , bananas
My numbers fluctuate , some more
9/14 T-291 LDL 177 HDL 104 try 49
Non HDL 187 T/hdl 2.7
Clearly the best numbers
But rose again
12/1-14 T349 LDL 227 HDL 109 try 63
Non HDL 250 T/hdl 3.2
There is hardly any changes in diet since I cut dairy, cocnut oil and butter
Of course , my MD want me to take statins
What I did so was take supplements to decrease chance of LDL oxidation- whey, vit C Tocotrienols EPA.
I think I have Familial Hypercholesteemia
My dad dies 90 , had CVD from his 70’s on. My Mom none and died at 86.
No heart attack in the 5 kids. But 3 take Statins. The oldest 68 had a calcium score too high to count
My calcium score was 459 which put me in the 98% for my 60 years.
I had a negative carotid u/s, and normal neuclear stress test and ECHO
I am 5 4″ 108 lbs and energetic
Help , do I take Statins ?
Thank you
Joan
maegen s says
February 18, 2015 at 04:05Hi! I just had several blood tests as I was severely I’ll from June 2014 until December 2015. I’ve started taking supplements at the urging of some of my specialists in neuroscience, endocrinology, and GI.
I feel great, was able to decrease number of meds, etC. Since Dec 2014.
However when I went back to check my.labs I had some strange outcomes. Your thoughts:
1- Cholesterol total 239 (was at 200 in October 2014)- I do not eat meat, dairy, or other high fat foods.
a- Non HDL at 173.
b- Triglycerides at 99.
I am overweight but I have lost over 60 pounds in 6 months.
My BMI is elevated but I don’t look particularly overweight. I’d imagine I’m around a 35 BMI. But I wear a size 14 pants which is average for my height and bone structure.
Would I be a candidate for statin drugs or should I try additional supplements and lifestyle changes first?
Heart disease and heart attacks- high cholesterol and high BP run in my family.
My “risk” ratio was 3.6 based on a 0-4 point scale.
Thanks! Meg
Jo Jacquette says
February 23, 2015 at 05:14I just got my cholesterol levels taken and am trying to figure out what they mean.. I hope you could help me.
It was a “random” testing
My results were as follows
Tc=169. I know is good
HDL=65. Again is good
Trg<45. Again good.
LDL=N/A. Which I was told was great
Non-hdl=104. Don't understand this and why is this high?
Tc/HDL=2.6. What is this number
GLU=82. Is this good?
Thanks for any help you can give
Axel F Sigurdsson says
February 25, 2015 at 15:54Jo Jacquette
A Non-HDL Cholesterol of 104 is indeed quite good. Tc/HDL is cholesterol divided by HDL cholesterol.
GLU (glucose) 82 suggests normal blood sugar (no diabetes).
Murugesan says
March 2, 2015 at 05:35Hello Dr., I have two simple questions (but for a dr. it may be a stupid question) regarding blood test during medical check-up. I just want to know out of my curiosity.
(i) During blood test, is the blood collected from in-coming blood vessel, i.e. the so called veins? How to ensure that blood is taken from vein and not from artery, suppose if they(both vein and artery) run side-by-side each other laterlly on the same plane?
(ii) If so, then how they differentiate the HDL from the total cholestrol? Are they(HDL) structurally different from the cholestrol (total cholestrol)?
Thanking you in advance.
Chris says
March 5, 2015 at 20:09Dr.,
I’m a little worried at my test results, I really don’t want to start a statin. I’m 36, 6’1, 220lbs, I could lose a few pounds. Recently I’ve been playing tennis 2 times a week. My results from 8/26/2014
Total Chol: 290
HDL: 50
LDL: 216
Trig: 122
Non-HDL: 240
My test results for 3/4/2015
Total Chol: 288
HDL: 51
LDL: 211
Trig: 129
Non-HDL: 237
Am I a walking time bomb?
Axel F Sigurdsson says
March 5, 2015 at 21:20Chris
No I don’t think you’re a walking time bomb.
Cardiovascular risk has to do with so much more than test results. You’re young and there’s lot you can do to improve the situation, some of it will syrely improve your numbers as well.
Try to lose weight. Eat healthy. Avoid sugars and refined carbs. Eat real natural food, vegetables, fruit, fish and meat. Healthy natural fats are fine in my opinion. Eggs are good for their nutritional value. Please don’t smoke. Look after your blood pressure. Exercise regularly.
Duncan Helmsworth says
March 5, 2015 at 21:19Dr.
Would like you thoughts
I am a 59 yo male. who exercises daily. Either 5 mile bike ride , and or crossfit style gym work out 3-4 x week. Family hx of heart disease (father MI at 52)
non smoker. On statins (simvastatin) last year when lipids were drawn
5-30-2014:
TC 182 mg/dl
HDL-C 98
LDL-C 71
TRIGLY 67
NON HDL 84
GLUCOSE 98
started following a Paleo type (not strict, but no processed food, corn or soy oils)diet. not long after that and feel great. cook with olive or coconut oils. Stopped my statin in october 2014 due to some muscle pain. Wasn’t sure if it was exercise or medication.
New Labs drawn 2-26-2015
TC 227
HDL-C 77
LDL-C 132
TRIGLY 88
NON HDL 150
GLUCOSE 94
Wondering if i should start back on statins??? muscle pain is improved even with more vigorous exercise.
any thoughts appreciated.
Axel F Sigurdsson says
March 5, 2015 at 22:50Duncan
It’s very difficult to advise someone you don’t know whether to take statins or not. That is something you will have to discuss with your doctor. Obviously, the drug did lower your total and LDL-cholesterol levels. How much that means in terms of risk reduction depends upon many factors (other risk factors, smoking, family history etc).
However, I want to congratulate you on your healthy lifestyle. Healthy diet and regular exercise will do wonders for your health and reduce the risk of disease although it will not affect your cholesterol numbers as effectively as the statins do.
Personally I’m rather restrictive with statins for healthy individuals.
Keep up the good work.
Rashi says
March 17, 2015 at 19:50Hello Doc,
I am 40 year old female. My blood profile was never this bad. Last month I had my blood tests and report came quite contrast to the previous one (I can’t remember the last units correctly). This time, Cholesterol- 5.24; Triglycerides- 2.67; HDL- 1.47; LDL- 2.55; non HDL cholesterol (calc)- 3.77; Hs CRP- 5.0; Ferritin- 6 (12-125); TSH- 4.43; free T4- 12 (12-22); Hb- 111.
Earlier my Doctor used to put me in low risk group, this time after 3 months I should go for another test and if results don’t come normal then she can put me on therapy to mainly lower the triglyceride levels. I reminded to her that these tests are done after I have started contraceptives (taking cyclen from last 5 months) but she doesn’t think that contraceptives can suddenly affect my blood profile. Earlier she never raised any issue. I am very afraid.
Whats your kind opinion; is contraceptive the main culprit?
Thanks,
Rashi
ingrid ortiz says
June 2, 2015 at 18:42Hi my son have 13 years old in blood test 05/09/2015 HDL 38 and non-hdl cholesterol is 144 is very bad for him??
Shamji says
September 13, 2015 at 21:02Hi Doctor,
I recently went for a complete Physical exam and came cross 4 test results where the results are slight above and below, So I wanted to check with you your opinion on the below results please:
CHOLESTEROL, TOTAL (MG/DL) – Above Normal – 221 where normal shows <200
LDL, (CALC.) (MG/DL) – Above Normal – 136 where normal shows <100
ALT (SGPT) (U/L) – Above Normal – 50 where it should be between 10-49
CO2 (BICARBONATE) (MEQ/L) – Below Normal – 18 where it should be 20-34.
Any advise from you is greatly appreciated. Also my NON-HDL is 163.
Thanks in advance
Shamji
Bonnie says
March 26, 2016 at 00:03I have just got results from lab work. HDL 82-LDL 181-Trig 146-Total chlol 292. I am 64 and female. How do I get LDL number down?
Johnny says
May 5, 2016 at 23:50Exercise 1/2 hour per day, try to drink a gallon of water every day, stop eating all processed sugar, reduce carb intake to less than 20 grams per meal, and eat lots of protein. Eat all the meat and fish you want, and throw away every jar of sauce in your fridge and don’t buy any more. Judging from your trigs I will bet you are either pre-diabetic or full on adult type 2 diabetic. You get the LDL number down by getting the HDL number UP and get the trigs down by reducing the carbs. It requires discipline to throw away everything in your fridge and cupboards and start over by restocking only low carb items and trade mono and polyunsaturated fats for saturated fat and trans fat but it’s the only way to change the numbers. But activity is #1. Even if you can only jog in place for two minutes at a stretch START DOING IT.
texasvet54 . says
September 28, 2016 at 05:16Hello Doc,
I’m new here and I think that your website is great.
I’m a 61 year old male, non-smoker, non-drinker and I weigh 182 pounds @ 6′ 1″. There is no heart disease anywhere in my family. I went to my cardiologist for episodes of acute hypertension with no angina and he talked me into a heart cath and he placed a stent in my circumflex 7 months ago. It turns out that I didn’t need the stent as my blockage was in the 30% to 40% range. I had this verified by two highly respected cardiologists. I’m now very concerned about my cardiovascular health and I’m looking for answers.
I’m currently taking:
81mg Aspirin
75mg Plavix
600mg Red Yeast Rice
400mg CoQ10
I’ve never smoked, I don’t drink and I limit my sugar intake.
My recent bloodwork was as follows:
Non-HDL Cholesterol = 104 mg/dL
Cholesterol = 142 mg/dL
Triglycerides = 74 mg/dL
HDL Cholesterol = 38 mg/dL
LDL Cholesterol = 89 mg/dL
Lp(a) = 10
I’ve done a ton of research on cholesterol and I’m finding more and more information indicating that the cholesterol studies of the 50’s/60’s/70’s were filled with poor scientific methods, cherry picking data and politics. I’ve come to the conclusion that maintaining a good weight, exercising, avoiding processed foods, eating fish regularly and adding more fruit and veggies to one’s diet has more of an impact on cardiovascular health than getting on statins and dealing with the leg cramps that I encountered when I was initially put on Lipitor after the stent.
While my bloodwork isn’t perfect, from what I can gather, it isn’t bad either.
I’m worried about blood clots and stenosis of the stent and I was wondering if you can give me any guidance in that area. My former cardiologist, the one that placed the stent, had told me that my LDL needed to be under 70, but everything that I’ve researched indicates that cholesterol isn’t the culprit in heart disease; stress and inflammation is. I’m unwilling to take large statin doses just to make my numbers a little bit better.
Any thoughts would be greatly appreciated!!!!!
John
Axel F Sigurdsson says
October 3, 2016 at 16:41Hi John
Well, I guess inappropriate stenting has become fairly common these days.
I think your emphasis on healthy lifestyle is a key issue here. Your dietary choices seem sensible and sound good to my ears. I’m also one of those who believes in the role of exercise, an intervention that is often highly underrated when it comes to keeping a good heart health.
The most important thing to avoid stent thrombosis (blood clotting) is dual antiplatelet therapy (DAP) with Aspirin and Clopidogrel (Plavix) for at least 6 months. We usually treat patients with acute coronary syndrome for 12 months with DAP.
I agree that your lipid panel looks fairly good. I assume that these numbers are off-statin. An LDL-C of less than 70 is usually regarded as the target value if you have vascular disease. Well, you’re not so far off then.
HDL-C is a difficult one. You might want to have a look at these articles:
https://www.docsopinion.com/2014/08/12/hdl-cholesterol/
https://www.docsopinion.com/2014/07/17/triglyceride-hdl-ratio/
You may find some tips there.
Then there’s the statin issue. That’s a difficult one also. I usually recommend statins for people in your situation. That advice is based on results from randomized clinical trials. However, some patients prefer not to take these drugs, usually due to side effects, or because they’ve read a lot of bad things about them on the internet 🙂 Of course I respect those decisions.
texasvet54 . says
January 10, 2017 at 03:34Thanks for the reply Doc. My new cardiologist put me on 10mg of Pravastatin two months ago and again, my legs became heavy and sore. So, I’m off of statins, probably for good, as I can’t find any studies showing that I will live any longer on statins.
On another note, I recently discovered that the reason my BP/HR was skyrocketing was because my family practitioner had increased my last annual steroid shot for my allergies from 40mg of Kenalog to 80mg of Kenalog without telling me. Six weeks later I received the stent that I didn’t need because my cardiologist apparently wanted to make a few more bucks. I can now see why the medical community is the third leading killer of man behind Heart Disease and Cancer. To say that I’m disgusted with my former doctors is an understatement.
So, I’m 62 now and wondering if I should give any concern whatsoever to my Lipid numbers. I’m in very good shape for my age and I exercise and eat well.
What more can I do?
Also, since I have a stent that I didn’t need, is my former native circumflex artery in worse shape than before the stent placement?
Maybe I should just try to put it out of my mind when I come off of the DAPT and hope that I live into my upper 80’s like all the men in my family.
Thanks,
John
Andrea says
October 3, 2016 at 02:36Exellent website, doc. I really appreciate your articles and education of public.
I have been on low carb diet for several years and recently started to experiment with ketogenic high fat diet. Just had my lipid profile done and all of my numbers increased.
Total cholesterol 6.16
HDL 3.24
LDL 2.69
Non HDL 2.92
Triglycerides 0.5
I am 50 years old, in avery good shape, exercise 3-4 times a week. Do you advise to continue my experiment or is the ketogenic diet too extreme? I do not think I produce a high amount of ketones at this point but I love what I eat and I feel great.
Axel F Sigurdsson says
October 3, 2016 at 07:25Andrea
These numbers are quite good indeed. They don’t call for a change. LDL-C is acceptable and the TG/HDL-C ratio is low which is very good. This ratio very often improves on a ketogenic diet. What many doctors worry about is that LDL-C often becomes very high which is not true in your case. Good luck.
Andrea says
October 3, 2016 at 14:43Doctor Axel, thank you very much for your reply.
I stumbled across your website and can’t stop reading. Thank you again for devoting your work to the newest research and educating the public.
Axel F Sigurdsson says
October 3, 2016 at 16:19Thanks Andrea.
Appreciate your interest.
Shining Shahin says
November 30, 2016 at 13:43I test my lipid profile today. Results total cholesterol is 165 mg/dl., HDL 36 mg/dl.,LDL 101mg/dl and non HDL cholesterol 129 mg/dl. Now what do I do?
What type of treatment require for me.
I feel pain in chest left side. ECG results normal
J A says
July 23, 2018 at 16:45This all information is good… but it doesn’t answer the question of how to *Raise* non HDL … as my patient report tells the non HDL to be less than 100 and that increases the risk of having heart disease! Kindly comment
Claudia Feige says
October 1, 2018 at 18:58I am a 50 year old female.I weigh 60kg and am 1.68m tall.I run 45km a week over 5 days,swim once a week. Non smoker, teetotaller, pescatarian. Perfect health.
My cholesterol results 2017: 2018:
Total cholesterol 4.2 5.8
Triglycerides 0.7 0.8
HDL 2.1 2.2
LDL 2.4 3.1
Non-HDL chol 2.1 3.6
Everything has remained the same except that I switched from using olive oil in 2017 to cook to using coconut oil in 2018.Also in 2018 less oatmeal in the morning but rather sourdough bread with cheese.
Why would there be such a big change for the worse?
How are my results, especially the non HDL cholesterol?
Many thanks,
Claudia