Skip to main content
Your session has expired. Reloading...
Cardiovascular

Non-HDL cholesterol: what the number counts, the 3.9 mmol/l limit and the targets

According to Thuisarts, the Dutch GPs' patient site, cholesterol is a fatty substance that the body makes in the liver and takes from food, and that it uses to make cells, hormones and bile. Non-HDL cholesterol counts the cholesterol in all particles in the blood except HDL, according to the Dutch guideline on cardiovascular risk management (CVRM) including LDL, VLDL, IDL and Lp(a): the atherogenic particles, which can cause hardening of the arteries.

According to Thuisarts, high cholesterol causes no symptoms, but if it is too high for years, the blood vessels can close up, usually slowly. According to a 2008 review, low cholesterol is generally uncommon, and then more often the result of another condition than of a rare inborn cause. Only a blood test shows how high non-HDL cholesterol is.

Star-SHL, Unilabs, Certe and Diagnostiek voor U give no reference value for non-HDL cholesterol; Unilabs lists 'Nvt' (not applicable) and refers to the targets. The CVRM guideline counts a non-fasting value above 3.9 mmol/l among the values that should be regarded as abnormal.

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 measures in millimoles per litre (mmol/l) how much cholesterol is in the blood outside the HDL particles: total cholesterol minus HDL cholesterol, as the CVRM guideline and Unilabs describe it. According to the CVRM guideline, the calculation is simple and free of cost.

Non-HDL Cholesterol: why this value matters

According to the CVRM guideline, non-HDL cholesterol includes all atherogenic lipid particles, which has the theoretical advantage that risk can be estimated better and the effect of treatment followed better. In the SCORE2 table, which estimates the ten-year risk of cardiovascular disease, non-HDL cholesterol sits next to sex, smoking status, age and systolic blood pressure.

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
Heart checkup · €209,- · General checkup · €199,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Non-HDL Cholesterol: when is testing worthwhile?

According to the CVRM guideline, non-HDL cholesterol can be measured without fasting, and the guideline advises measuring the lipid profile of total cholesterol, triglycerides, HDL and LDL without fasting as well. With treatment with cholesterol-lowering medicines, the CVRM guideline advises using LDL or non-HDL cholesterol to follow the effect.

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

Low Levels

A low non-HDL cholesterol follows arithmetically from a low total or LDL cholesterol, and no laboratory gives a lower limit for non-HDL cholesterol itself. According to a 2008 review, low cholesterol is frequently seen in severe chronic liver failure, and chronic inflammation can also lower cholesterol.

High Levels

A high non-HDL cholesterol means more cholesterol in the particles that can cause hardening of the arteries. If cholesterol is too high for years, Thuisarts names a greater risk of, among others, chest pain (angina), kidney damage, peripheral artery disease, a heart attack and a stroke, although not everyone with high cholesterol gets these diseases.

According to the guideline on inherited dyslipidaemia, a physical examination of someone with high cholesterol looks for tendon xanthomas, cholesterol deposits in tendons that are characteristic of familial hypercholesterolaemia (FH), an inherited high cholesterol.

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

A high non-HDL cholesterol is one to discuss with your GP, who according to Thuisarts can work out how great the risk of cardiovascular disease is. According to Thuisarts, high cholesterol can come from several things, including too little exercise, unhealthy eating and drinking, and being overweight.

Non-HDL Cholesterol: frequently asked questions

Do you need to fast for non-HDL cholesterol?

No, you do not need to fast for non-HDL cholesterol: according to the CVRM guideline it can be measured without fasting. When non-fasting triglycerides are higher than 5 mmol/l, the guideline advises measuring triglycerides fasting.

Is 3.9 mmol/l a normal value for non-HDL cholesterol?

No, the 3.9 mmol/l limit for a non-fasting non-HDL cholesterol is a cut-point based on a desirable concentration, according to the 2016 European consensus of the EAS and the EFLM. In the Danish population study that consensus used, with 92,285 men and women, 50% were at or above 3.9 mmol/l.

Is non-HDL cholesterol always on the result?

According to the CVRM guideline, non-HDL cholesterol is already often calculated and reported automatically by laboratories. Unilabs calculates it automatically when cholesterol and HDL are requested from primary care.

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.

Heart & vessels

Heart checkup

An extensive blood test with 12 heart and vessel values — the full cholesterol profile, Apo(B), Lp(a), hsCRP, homocysteine and blood sugar — for insight into your heart and vessel health.

Total Cholesterol LDL Cholesterol HDL Cholesterol Non-HDL Cholesterol Cholesterol/HDL Ratio Triglycerides ApoB (Apolipoprotein B) Lipoprotein(a) hs-CRP (High Sensitivity CRP) Glucose (Fasting) HbA1c (Glycated Hemoglobin) Creatinine eGFR (Estimated Glomerular Filtration Rate) LDL/HDL Ratio
€209,-
General checkup

General checkup

A broad blood test covering 18 values across liver, kidneys, thyroid, heart, vitamins and blood count.

ALT (Alanine Aminotransferase) GGT (Gamma-Glutamyl Transferase) Creatinine eGFR (Estimated Glomerular Filtration Rate) TSH (Thyroid Stimulating Hormone) Total Cholesterol HDL Cholesterol LDL Cholesterol Triglycerides Glucose (Fasting) Vitamin D (25-OH) Vitamin B12 Ferritin Hemoglobin Leukocytes (WBC) Platelets (Thrombocytes) CRP (C-Reactive Protein) MCV (Mean Corpuscular Volume) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€199,-

Medical reviewer

Medical standards

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

Medical policy
CIBG Ministerie van Volksgezondheid,
Welzijn en Sport Official BIG registration BIG 49928676701 Opens in a new tab