Lipids – Heart Healthy Toolbox

A complement to other PCNA resources, this healthcare provider tool focuses on non-HDL-C: how it is determined, and recommendations for treatment based on risk categories.

Components

You can also view all sections of the Heart Healthy Toolbox.

For Providers

• Non-HDL-C=Total Cholesterol Minus HDL-C (also available below)

Non-HDL-C = Total Cholesterol Minus HDL-C

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. In persons aged 20 and older with elevated triglycerides (TG)of 175-499 mg/dL, most cholesterol occurring in the VLDL fraction is contained in the remnant VLDL, which is thought to be very atherogenic. The non-HDL-C level includes cholesterol carried in several atherogenic lipoproteins, such as LDL, very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and lipoprotein(a) (Lp(a)).

Therefore, in patients aged 20 and older with elevated TG levels, 175-499 mg/dL, the class I recommendation includes identifying and treating secondary factors (lifestyle, secondary disorders, and/or medication).

The class IIa recommendation for ages 40-75 with severe hypertriglyceridemia >500 mg/dL with an ASCVD risk of ≥7.5% for whom secondary factors (above) have been addressed; it identifies persistently elevated TG as a risk enhancer which favors initiation or intensification
of statin therapy to reduce ASCVD risk.

Another class IIa recommendation is for those with TG ≥ 1,000 addresses many factors traditionally discussed in the management of hypertriglyceridemia.

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

National Cholesterol Guidelines

• Grundy SM, Stone NJ, Bailey AL. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 2019; 73(24):3168–3209.  doi.org/10.1016/j.jacc.2018.11.002
• Total and HDL Levels in US Adults 2021-2023 Carroll MD, Fryar CD, Bwira JA, Iniguez M. Total and High-density Lipoprotein Cholesterol in Adults: United States, August 2021-August 2023. (PDF) NCHS Data Brief. 2024. Accessed July 18, 2025.

10-YEAR RISK ASSESSMENT TOOL

• ASCVD Risk Estimator, American College of Cardiology. tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
• PREVENT Online Calculator, American Heart Association. professional.heart.org/en/guidelines-and-statements/prevent-calculator
• Understanding Your Risk for Heart Disease and Stroke Fact Sheet, Preventive Cardiovascular Nurses Association. pcna.net/resource/understanding- your-risk-for-heart-disease-and-stroke-fact-sheet/
• For Lipid Reference Values, visit NIH’s Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults

Supported by independent educational grants from Merck & Co, Inc. and Novartis Pharmaceuticals Corporation.