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Cardiovascular

Non-HDL cholesterol: what food, weight and exercise have to do with this number

Cholesterol is a fatty substance that your body partly makes itself in the liver and partly takes from your food, and according to Thuisarts it uses it to make cells, hormones and bile. Non-HDL cholesterol is all the cholesterol in your blood except HDL: besides LDL also the cholesterol in VLDL, IDL and Lp(a), particles that according to the CVRM guideline can cause hardening of the arteries.

According to Thuisarts, high cholesterol can come from unhealthy eating, being overweight and too little exercise, among others, and causes no symptoms itself, while years of cholesterol that is too high raise the risk of kidney damage and peripheral artery disease, among others, according to Thuisarts. You only see how high your non-HDL cholesterol is in a blood test.

According to the 2016 European consensus of the EAS and EFLM, a laboratory should flag a non-fasting non-HDL cholesterol from 3.9 mmol/l, a cut-point based on a desirable concentration.

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 a calculated value in millimoles per litre (mmol/l): your total cholesterol minus your HDL cholesterol. According to the CVRM guideline, the number includes the cholesterol in all atherogenic particles, the particles that can cause hardening of the arteries, and Unilabs works it out automatically when cholesterol and HDL are requested from primary care.

Non-HDL Cholesterol: why this value matters

According to the CVRM guideline, non-HDL cholesterol also contains the cholesterol in particles carrying the protein apoB, and according to the guideline on inherited dyslipidaemia, someone with a normal LDL cholesterol but a raised number of LDL particles, an apoB above 1.2 g/l, has a higher risk of cardiovascular disease than someone with a normal LDL cholesterol and a normal apoB. A raised number of LDL particles with a normal LDL cholesterol often occurs, according to the guideline on inherited dyslipidaemia, in many secondary forms of dyslipidaemia, a disturbed blood lipid level caused by another condition, for example with type 2 diabetes, overweight and metabolic syndrome.

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
Lipid Screening · €80,- · GLP-1 Check-in Panel · €109,- · GLP-1 Extended Panel · €196,- · GLP-1 Baseline Panel · €214,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Non-HDL Cholesterol: when is testing worthwhile?

You can have non-HDL cholesterol measured without fasting, and the 2016 European consensus of the EAS and EFLM states that fasting is not routinely required for a lipid profile.

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

Low Levels

A low non-HDL cholesterol can go with undernutrition or poor fat absorption, which according to a 2008 review can lead to low blood lipids, because dietary fat is the outside source of blood lipids.

High Levels

Thuisarts writes that high cholesterol causes no symptoms, so a high non-HDL cholesterol also goes unnoticed without a blood test. According to Thuisarts, cholesterol that stays too high for years can make the blood vessels close up; this usually happens slowly, and in this way less and less blood flows through them and the risk of a heart attack or a stroke rises, according to Thuisarts.

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

According to Thuisarts, high cholesterol, of which non-HDL cholesterol is the part outside HDL, can come from unhealthy eating: little vegetables, fruit, pulses, nuts and wholegrain products, and a lot of sugar and saturated fat. According to Thuisarts, saturated fat is found a lot in cheese, butter, whole milk, fatty meat, cold cuts and sausage.

Non-HDL Cholesterol: frequently asked questions

Is 3.9 mmol/l a healthy limit for non-HDL cholesterol?

According to the European consensus of the EAS and EFLM, the 3.9 mmol/l limit for a non-fasting non-HDL cholesterol is a cut-point based on a desirable concentration: in a Danish population study, half of the participants were at or above 3.9 mmol/l.

Can low cholesterol come from eating too little?

Yes, according to a 2008 review low cholesterol can arise from undernutrition or poor fat absorption. According to that review, low cholesterol is generally uncommon.

Why do you not need to fast for non-HDL cholesterol?

You do not need to fast for non-HDL cholesterol, because the 2016 European consensus of the EAS and EFLM states that fasting is not routinely required for a lipid profile. The Dutch CVRM guideline says that non-HDL cholesterol can be measured without fasting.

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.

GLP-1

GLP-1 Check-in Panel

The 3-month safety and progress check clinics do: pancreas, liver, kidneys, salts and your metabolic progress on GLP-1 medication.

ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Potassium Sodium Glucose (Fasting) Total Cholesterol Lipase Creatinine Triglycerides eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€109,-
GLP-1

GLP-1 Extended Panel

The 6-month measurement: everything from the check-in plus insulin, ApoB and your nutrients — especially relevant if you have been eating much less for a while.

Insulin (Fasting) ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€196,-
GLP-1

GLP-1 Baseline Panel

Your starting point before the first injection: blood sugar, cholesterol, pancreas, liver, kidneys, thyroid and nutrients in one measurement.

Insulin (Fasting) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Bilirubin (Total) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides Bilirubin (Direct) Bilirubin (Indirect) HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€214,-

Medical reviewer

Medical standards

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

Medical policy
CIBG Ministerie van Volksgezondheid,
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