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Cardiovascular

Non-HDL cholesterol: what the number counts, the targets and the role of the thyroid

According to Thuisarts, cholesterol is a fatty substance with which the body makes cells, hormones and bile. Non-HDL cholesterol includes the cholesterol in all particles that the CVRM guideline calls atherogenic, particles that can cause hardening of the arteries, and leaves out HDL, of which Thuisarts says a high value is actually good for the blood vessels.

According to Thuisarts, high cholesterol causes no symptoms, yet when it stays raised for years the risk of heart and vascular disease goes up. Only a blood test shows whether your non-HDL cholesterol is raised.

Certe names only targets for non-HDL cholesterol, for following cholesterol-lowering treatment: < 2.6 mmol/l in patients with cardiovascular disease under 70, and < 3.4 mmol/l with a high or very high cardiovascular risk, diabetes mellitus and/or chronic kidney damage.

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 gives the cholesterol outside HDL in millimoles per litre (mmol/l), calculated as total cholesterol minus HDL cholesterol. Certe writes that LDL or non-HDL cholesterol is used to follow the effect of cholesterol-lowering treatment.

Non-HDL Cholesterol: why this value matters

According to the CVRM guideline, non-HDL cholesterol includes the cholesterol in all apoB-containing, 'bad' lipoproteins, and therefore replaces the ratio of total cholesterol to HDL in the SCORE2 models. With cholesterol that is too high for years, Thuisarts names angina, a heart attack, a stroke and kidney damage, among others, as diseases whose risk grows.

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.
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Non-HDL Cholesterol: when is testing worthwhile?

Non-HDL cholesterol does not need to be measured fasting, and with high cholesterol the guideline on inherited dyslipidaemia advises measuring the thyroid value TSH, among others, to rule out a secondary cause such as an underactive thyroid. The same guideline also names creatinine and protein in the urine for this.

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

Low Levels

A low non-HDL cholesterol can follow from an overactive thyroid, which according to a 2008 review goes with lower total, LDL and HDL cholesterol. That review does not discuss non-HDL cholesterol itself.

High Levels

A high non-HDL cholesterol causes no symptoms, Thuisarts writes about high cholesterol. When cholesterol stays too high for years, the blood vessels can close up, according to Thuisarts, usually slowly and a little more over time, with a greater chance of angina, a heart attack, a stroke and peripheral artery disease.

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

Non-HDL cholesterol is part of total cholesterol, and with high cholesterol the risk of cardiovascular disease grows with smoking, high blood pressure, diabetes and rheumatism, among others, according to Thuisarts. A high non-HDL cholesterol is one to discuss with your GP.

Non-HDL Cholesterol: frequently asked questions

Can an underactive thyroid raise cholesterol?

Yes, according to Thuisarts an underactive thyroid can cause high cholesterol, and the guideline on inherited dyslipidaemia calls hypothyroidism a secondary cause of raised total and LDL cholesterol. Because LDL cholesterol is part of non-HDL cholesterol, a raised LDL also raises the non-HDL value.

Does the HDL limit differ between men and women?

Yes, Star-SHL gives 0.9 to 1.7 mmol/l for HDL cholesterol in men and 1.1 to 2.0 mmol/l in women, and the European consensus of the EAS and EFLM allows sex-specific cut-points for HDL. None of the laboratories gives a reference value for non-HDL cholesterol, for women or for men.

When does a target of 3.4 mmol/l apply?

According to Certe, a target of < 3.4 mmol/l for non-HDL cholesterol applies to patients with a high or very high cardiovascular risk, diabetes mellitus and/or chronic kidney damage. Certe names that value when following cholesterol-lowering treatment.

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

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