How Do You Calculate LDL and Non-HDL Cholesterol?

The sum of Very Low Density Lipoprotein (VLDL) +LDL cholesterol is called non-HDL cholesterol. It is calculated routinely as total cholesterol minus HDL cholesterol.Non-HDL cholesterol (non-HDL-C) represents the cholesterol components carried by atherogenic lipoproteins such as LDL, very low-density lipoprotein (VLDL) and intermediate density lipoprotein (IDL). Higher non-HDL-C levels indicate increased risk of atherosclerosis.

According to the ESC cholesterol guideline, non-HDL-C evaluation is recommended for risk assessment, particularly in people with high TG levels, diabetes, obesity, or very low LDL-C levels.

Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories

Risk CategoryNon-HDL Secondary Goal
Very High-Risk Individuals< 85 mg/dL
High-Risk Individuals100 mg/dL
Moderate-Risk Individuals130 mg/dL

The 2019 AHA/ACC cholesterol guideline identifies four statin treatment groups:

  • Secondary ASCVD prevention for which high-intensity statin therapy is recommended;
  • Severe hypercholesterolemia (LDL-C 190 mg/dL or greater) for which maximally-tolerated statin therapy is recommended;
  • Patients with diabetes for which moderate- or high-intensity statin therapy is recommended depending upon risk; and
  • Primary prevention

The use of statin therapy in primary prevention patient begins with ASCVD risk estimation using pooled cohort equations (tools.acc.org/ascvd-risk-estimator) and considers the presence of risk enhancing factors (see guideline), and the patient's thoughts and values. Although the guideline recommends statin therapy when 10-year risk estimate is 7.5% or greater, a clinician-patient risk discussion must occur before prescribing a statin.

References:

American Heart Association. Cholesterol Management Guide for Healthcare Practitioners. https://www.heart.org/-/media/files/health-topics/cholesterol/chlstrmngmntgd_181110.pdf. Accessed April 30, 2020.

Arnett, DK, Blumentahl RS, Albert A, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019;140:e596-e646. https://doi.org/10.1161/CIR.0000000000000678.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019;139;e1082-e1143. https://doi.org/10.11161/CIR.0000000000000625.

Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal. 2019;41:1,111-188. https://doi.org/10.1093/eurheartj/ehz455.