How This Helps

Your non-HDL cholesterol refers to the total cholesterol value minus your HDL cholesterol. When you get your blood drawn for a cholesterol test (a lipid profile or lipid panel), the report generally includes four numbers: low-density lipoprotein (LDL) cholesterol; high-density lipoprotein (HDL) cholesterol; triglycerides; and total cholesterol. In recent years, the topic of cholesterol has been hotly debated. How to measure it, how to treat high cholesterol, and whether there is any need to treat it even, are just many of the issues that have been surrounding the subject of cholesterol in recent years.[1] One topic that has not found much space in all this discussion is non-HDL cholesterol. In fact, not many people are even aware of what is non-HDL cholesterol. Read on to find out more about non-HDL cholesterol and what does it indicate.

What is Non-HDL Cholesterol?

You might have seen a mention of non-HDL cholesterol in a cholesterol test report if you ever got your cholesterol levels tested. If you have gotten cholesterol test done, then you know that cholesterol readings are quite confusing. Many people even believe that cholesterol testing is entirely unnecessary.[2] Nevertheless, in these test results, you are likely to find your total cholesterol levels, HDL (good cholesterol) levels, LDL (bad cholesterol) levels, and also non-HDL cholesterol level. 

Non-HDL cholesterol is the value you get when you subtract your high-density lipoprotein (HDL or good) cholesterol number from the total cholesterol number. Non-HDL cholesterol can, therefore, be said to be the number of all the 'bad' type of cholesterol in the bloodstream.[3] Many doctors now believe that your non-HDL cholesterol level may be a good indicator of your risk of heart disease.[4]

See: Dark chocolate consumption increases HDL cholesterol concentration and chocolate fatty acids may inhibit lipid peroxidation in healthy humans.

Non-HDL cholesterol vs. other cholesterol numbers

How is Non-HDL Cholesterol reading different than other cholesterol numbers?

In order to determine your cholesterol level, most doctors prescribe a simple blood test known as the lipid panel. The results of this blood test will provide you with your total cholesterol levels. However, to understand your risk of heart disease, total cholesterol is further segmented into:

·        HDL cholesterol

·        LDL cholesterol

·        Non-HDL Cholesterol

·        Triglycerides

HDL cholesterol lets you know the amount of good cholesterol in your body, while LDL cholesterol lets you know how much of 'bad' cholesterol is present in your bloodstream. The higher the number of HDL cholesterol, the lower is your risk of developing heart-related issues.[5] However, if you have high levels of LDL cholesterol, it means you are at a high risk of heart disease, and it can clog your arteries, thus restricting the blood flow. This can potentially lead to a stroke or heart attack. The levels of LDL cholesterol should ideally be as low as possible.[6] Triglycerides, on the other hand, are a form of fat that you derive from the food you eat. When you consume more calories than what you burn off, then this leads to a buildup of excess triglycerides. Similar to a high level of LDL cholesterol, high levels of triglycerides in the bloodstream are also associated with heart disease.[7, 8] 

Non-HDL levels indicate how much total 'bad' cholesterol is present in the bloodstream. It is necessary to understand all the components that make up total cholesterol because all of these are ultimately related and together determine your risk of heart disease.[9] Keeping the previous factors in mind, your non-HDL number should also be on the lower side.

See: How long does it take to reduce cholesterol

What is the normal range of non-HDL cholesterol?

As mentioned above, the higher the numbers for non-HDL cholesterol, the higher the risk of heart disease. The levels of non-HDL cholesterol should ideally be kept below 130 milligrams per deciliter (mg/dL).[10] The higher these numbers are, the higher is your risk of heart disease. 

The optimum level of non-HDL cholesterol is based on research on over 200 heart patients who successfully lowered their non-HDL cholesterol levels over one year.[11] 

In those who already suffer from coronary artery disease or are at a very high risk of heart disease, the ideal number of non-HDL cholesterol should not be above 100 mg/dL. This includes those with diabetes, who have already had a heart attack or frequently experience chest pain, or people who already have severely clogged arteries.[12]  Another study carried out over a period of ten years found that non-HDL cholesterol levels greater than 160 mg/dL were associated with a 50 to 80 percent increased risk of dying from heart disease.[13]

See: Ayurvedic treatment for High Cholesterol and Triglycerides

How can you lower Non-HDL cholesterol?

How to Lower Non-HDL Cholesterol?

When you lower the levels of non-HDL cholesterol, you are also significantly reducing the risk of heart disease. Changing what you eat can help reduce your non-HDL cholesterol, LDL cholesterol, and triglyceride levels as well. Your diet has a central role to play in your total cholesterol levels and increasing the consumption of foods that lower non-HDL cholesterol can is one of the easiest ways of maintaining your cholesterol numbers.[14]

To reduce your non-HDL cholesterol levels, the first step should be to limit the intake of saturated fats. This means cutting down your consumption of full-fat dairy and fatty meat products. Along with saturated fats, you should also avoid trans fats, which may also be listed as hydrogenated or partially hydrogenated vegetable oil. Trans fats are also known to increase the risk of heart disease.[15] These are likely to be found in the following products:

·        Snacks like microwaveable popcorn, crackers, meat pies, and frozen pizza crusts

·        Baked goods such as cakes, pastries, store-bought cookies, etc.

·        Fried fast foods such as fried fish, fried noodles, French fries, and fried chicken

·        Margarine made from hydrogenated vegetable oils

Other foods that can help you reduce your non-HDL cholesterol levels include:

·        Oats: Fibers present in oatmeal naturally mix with cholesterol in your small intestine and binds to the cholesterol molecules in the blood, preventing the cholesterol from getting absorbed in the bloodstream. Oatmeal is highly effective in lowering non-HDL cholesterol.[16]

·        Nuts: They are not only high in healthy fats but also rich in protein and fiber. Many studies have shown that nuts can successfully lower non-HDL cholesterol and also reduce the risk of heart disease.[17] Try snacking on almonds, pistachios, walnuts, cashews, pecans, and macadamia nuts for lowering your non-HDL cholesterol. 

·        Vegetables: Vegetables are rich in antioxidants, fiber, and also low in calories. Vegetables such as eggplants, carrots, potatoes, and okra are high in pectin, which helps lower non-HDL cholesterol.[18]

See: How to lower cholesterol naturally

Cholesterol ratio vs. non-HDL cholesterol

Although you may assume total cholesterol is just the amount of your LDL and HDL,  it has very-low-density lipoprotein (VLDL). These particles carry triglycerides to cells and finally become LDL. Like LDL, additionally, it causes cholesterol to accumulate on the inside of arteries, creating artery-clogging plaque. Both are deemed undesirable, so the higher your LDL and VLDL values, the greater your risk of cardiovascular disease.[20] Blood levels of triglycerides vary depending on when and what you've eaten, which is the reason the majority of cholesterol tests are done after a person has fasted for at least 12 hours. In this way, the outcomes can be more readily compared between people. However, the non-HDL cholesterol calculation doesn't rely upon a triglyceride value, therefore there's no need to fast. What's more, the non-HDL cholesterol value reflects all the significant lipoproteins linked with a greater risk of cardiovascular disease.


How significant are cholesterol ratio and non-HDL cholesterol?

For predicting your risk of cardiovascular disease, many physicians now think that determining your non-HDL cholesterol level might be more useful than calculating your cholesterol ratio. And either option seems to be a better risk predictor than your overall cholesterol level or even your LDL cholesterol level.

Non-HDL cholesterol, as its title suggests, simply subtracts your high-density lipoprotein (HDL, or"good") cholesterol number in the total cholesterol number. So it contains all of the "bad" forms of cholesterol.

An optimal amount of non-HDL cholesterol is less than 130 mg per deciliter (mg/dL), or 3.37 millimoles per liter (mmol/L). Higher numbers mean a greater chance of cardiovascular disease. To compute your cholesterol ratio, divide your total cholesterol number by your HDL cholesterol number. If your total cholesterol value is 200 mg/dL as an example, and your HDL is 40 mg/dL, your ratio will be 5-to-1. Higher ratios mean a greater chance of cardiovascular disease. [19]

 

See: Garlic Health Benefits, Nutrition & Side Effects

Summary

High levels of non-HDL cholesterol indicate that you are at a higher risk of heart disease. This is why maintaining the levels of non-HDL cholesterol should be a priority, especially if you have a chronic underlying disease such as diabetes, liver disease, or kidney disease. Making certain lifestyle changes, eating a healthy diet, regularly exercising, and avoiding smoking and drinking alcohol are all necessary for maintaining a healthy level of non-HDL cholesterol.

See: Heart healthy diet plan to prevent heart disease

References

1. Leslie, M., 2017. To help save the heart, is it time to retire cholesterol tests?.

2. Doll, H., Shine, B., Kay, J., James, T. and Glasziou, P., 2011. The rise of cholesterol testing: how much is unnecessary. Br J Gen Pract, 61(583), pp.e81-e88.

3. Blaha, M.J., Blumenthal, R.S., Brinton, E.A., Jacobson, T.A. and National Lipid Association Taskforce on Non-HDL Cholesterol, 2008. The importance of non–HDL cholesterol reporting in lipid management. Journal of clinical lipidology, 2(4), pp.267-273.

4. Packard, C.J. and Saito, Y., 2004. Non− HDL Cholesterol as a Measure of Atherosclerotic Risk. Journal of atherosclerosis and thrombosis, 11(1), pp.6-14.

5. Brewer Jr, H.B., 2004. Increasing HDL cholesterol levels. New England Journal of Medicine, 350(15), pp.1491-1494.

6. Ridker, P.M., 2014. LDL cholesterol: controversies and future therapeutic directions. The Lancet, 384(9943), pp.607-617.

7. Bookstein, L., Gidding, S.S., Donovan, M. and Smith, F.A., 1990. Day-to-day variability of serum cholesterol, triglyceride, and high-density lipoprotein cholesterol levels. Archives of internal medicine, 150(8), pp.1653-1657.

8. Cullen, P., 2000. Evidence that triglycerides are an independent coronary heart disease risk factor. The American journal of cardiology, 86(9), pp.943-949.

9. Lemieux, I., Lamarche, B., Couillard, C., Pascot, A., Cantin, B., Bergeron, J., Dagenais, G.R. and Després, J.P., 2001. Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: the Quebec Cardiovascular Study. Archives of internal medicine, 161(22), pp.2685-2692.

10. Cannon, C.P., Blazing, M.A., Giugliano, R.P., McCagg, A., White, J.A., Theroux, P., Darius, H., Lewis, B.S., Ophuis, T.O., Jukema, J.W. and De Ferrari, G.M., 2015. Ezetimibe added to statin therapy after acute coronary syndromes. New England Journal of Medicine, 372(25), pp.2387-2397.

11. Tsujita, K., Sugiyama, S., Sumida, H., Shimomura, H., Yamashita, T., Yamanaga, K., Komura, N., Sakamoto, K., Oka, H., Nakao, K. and Nakamura, S., 2015. Impact of dual lipid-lowering strategy with ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention: the multicenter randomized controlled PRECISE-IVUS trial. Journal of the American College of Cardiology, 66(5), pp.495-507.

12. Blaha, M.J., Blumenthal, R.S., Brinton, E.A., Jacobson, T.A. and National Lipid Association Taskforce on Non-HDL Cholesterol, 2008. The importance of non–HDL cholesterol reporting in lipid management. Journal of clinical lipidology, 2(4), pp.267-273.

13. Abdullah, S.M., Defina, L.F., Leonard, D., Barlow, C.E., Radford, N.B., Willis, B.L., Rohatgi, A., McGuire, D.K., de Lemos, J.A., Grundy, S.M. and Berry, J.D., 2018. Long-term association of low-density lipoprotein cholesterol with cardiovascular mortality in individuals at low 10-year risk of atherosclerotic cardiovascular disease: results from the Cooper Center Longitudinal Study. Circulation, 138(21), pp.2315-2325.

14. Gertler, M.M., Garn, S.M. and White, P.D., 1950. Diet, serum cholesterol and coronary artery disease. Circulation, 2(5), pp.696-704.

15. Ascherio, A., Katan, M.B., Zock, P.L., Stampfer, M.J. and Willett, W.C., 1999. Trans fatty acids and coronary heart disease. New England Journal of Medicine, 340, pp.1994-1998.

16. Grundy, M.M.L., Fardet, A., Tosh, S.M., Rich, G.T. and Wilde, P.J., 2018. Processing of oat: the impact on oat's cholesterol lowering effect. Food & function, 9(3), pp.1328-1343.

17. Chisholm, A., Mc Auley, K., Mann, J., Williams, S. and Skeaff, M., 2005. Cholesterol lowering effects of nuts compared with a Canola oil enriched cereal of similar fat composition. Nutrition, Metabolism and Cardiovascular Diseases, 15(4), pp.284-292.

18. Brouns, F., Theuwissen, E., Adam, A., Bell, M., Berger, A. and Mensink, R.P., 2012. Cholesterol-lowering properties of different pectin types in mildly hyper-cholesterolemic men and women. European journal of clinical nutrition, 66(5), pp.591-599.

19. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol-ratio/faq-20058006

20. https://www.health.harvard.edu/heart-health/non-hdl-cholesterol-explained

See: Ayurveda for heart health

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