About the Test
Purpose of the test
The purpose of a non-HDL cholesterol test is to determine the amount of “bad” cholesterol in the blood. This common way of assessing cardiovascular health is done by first measuring total cholesterol and subtracting HDL cholesterol. Non-HDL cholesterol tests can be used for diagnosis, screening, and monitoring .
- Diagnosis is identifying the cause of a health problem after symptoms have started. Tests that measure cholesterol, including non-HDL cholesterol, may be part of the evaluation of patients with symptoms that are consistent with cardiovascular disease. Cholesterol may also be tested to diagnose some conditions affecting the liver, pancreas, or thyroid.
- Screening is checking for a health problem before there are any symptoms. Periodic cholesterol testing is often done to identify children and adults who have high levels of non-HDL cholesterol, which is associated with an elevated risk of cardiovascular problems like heart disease, heart attack, and stroke.
- Monitoring is testing done to see how a patient’s condition has changed, including in response to treatment. If you have had abnormal cholesterol levels in the past or have been diagnosed with a cardiovascular disease you may be monitored with repeated cholesterol tests over time.
What does the test measure?
A non-HDL cholesterol test involves at least three components:
- Total cholesterol: This is a measurement of the sum of all cholesterol in a sample of blood.
- HDL cholesterol: This is a direct measurement of “good” cholesterol that is found in HDLs. Lipoproteins are particles made up of protein and fat that carry cholesterol in the blood.
- Non-HDL cholesterol: This is a simple calculation made by subtracting the measured amount of HDL cholesterol from the measured amount of total cholesterol.
Non-HDL cholesterol includes multiple different cholesterol containing lipoproteins that can build up in the arteries and increase the risk of serious health problems. Specifically, non-HDL cholesterol encompasses low-density lipoprotein (LDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, intermediate-density lipoprotein (IDL) cholesterol, and lipoprotein(a).
When should I get a non-HDL cholesterol test?
Cholesterol testing can be ordered in many different circumstances. Whether testing is appropriate for you depends on your specific situation.
There are no strict guidelines for when to perform health screenings that include cholesterol testing. The age at which to start screening and how frequently screening is repeated may depend on whether you have risk factors for cardiovascular disease. Examples of risk factors include:
- High blood pressure
- Diabetes
- Cigarette smoking
- A family history of heart disease that occurs at an early age
Your doctor can review your risk factors and describe the optimal schedule for screening in your case. Although not all experts agree on the best schedule for cholesterol screening, many health professionals follow recommendations similar to those described in the table below:
| DEMOGRAPHIC GROUP | RISK FACTORS | SCREENING FREQUENCY |
|---|---|---|
| Children | No risk factors | Once between ages 9-11; again between ages 17-21 |
| Children | One or more risk factors | Every 1-3 years starting when the risk factor is identified |
| Adolescents and adults of any age | One or more risk factors | At least every 5 years; often more frequently based on specific risk factors |
| Males ages 20-45
Females ages 20-55 |
No risk factors | Every 4-6 years |
| Males ages 45-65
Females ages 55-65 |
No risk factors | Every 1-2 years |
| People over age 65 | With or without risk factors | Annually |
Screening generally involves measuring at least total cholesterol and HDL cholesterol, which allows non-HDL cholesterol to be calculated. In many cases, a full lipid panel is used for screening, which shows an estimated level of LDL cholesterol along with total cholesterol, HDL cholesterol, and another fat-like substance called triglycerides.
As a method of monitoring cardiovascular health, cholesterol tests are most frequently used if:
- You have previously been diagnosed with heart disease or another cardiovascular problem
- You have had abnormal cholesterol levels in the past, such as elevated non-HDL cholesterol
- You are making lifestyle changes and/or taking medications as a form of treatment to improve your cardiovascular health
While less often used for diagnosis, cholesterol testing might be included in the diagnostic process if you have symptoms that may be related to problems affecting the liver, thyroid, pancreas, or cardiovascular system.
Because cholesterol testing is prescribed according to many individual factors, your doctor is in the best position to address when you should have a cholesterol test that assesses non-HDL cholesterol.
Finding a Non-High-Density Lipoprotein Cholesterol Test
How can I get a non-HDL cholesterol test?
Non-HDL cholesterol can be calculated as part of testing that measures total cholesterol and HDL cholesterol. These tests are usually ordered by a doctor. A blood sample is required for these tests and they can be taken at a medical office, laboratory, or hospital. A laboratory analyzes the sample to determine the amounts of different kinds of cholesterol in the blood.
Some cholesterol tests are performed on-site without having to send a sample to a laboratory. This is known as point-of-care testing, and it is done with a drop of blood from your fingertip. Point-of-care tests provide rapid results and may be done in hospitals, clinics, pharmacies, or events such as health fairs.
Can I take the test at home?
Cholesterol can be measured with different kinds of at-home tests, including self-tests and self-collection kits.
- Self-tests involve placing a drop of blood from your fingertip onto special test paper. In most cases, that paper is then placed in a small device that determines cholesterol levels. Some self-tests use test paper that changes color based on cholesterol levels. If a self-test measures total cholesterol and HDL cholesterol, those values can be used to calculate the amount of non-HDL cholesterol.
- Self-collection kits allow you to take a blood sample from your fingertip and mail it to a laboratory. Results are usually provided within a few days through an online health portal. The test may include non-HDL cholesterol, or you may be able to calculate this yourself if total cholesterol and HDL cholesterol are analyzed. You can order a test kit online and take your sample to a local lab for testing, with results in two to five days.
How much does the test cost?
There is no set price for a non-HDL cholesterol test. Instead, the cost depends on whether you have insurance coverage and where the blood sample is taken and analyzed.
The cost of a non-HDL cholesterol test can vary based on factors including:
- The number of measurements included in the test
- Whether it is a laboratory or point-of-care test
- Where the test is conducted
- Whether the test is covered by health insurance
Charges can arise related to office visits, taking the test sample, and analyzing your blood. These charges may be covered by insurance, especially if your doctor prescribes the test. However, you may still have copayments or costs toward your deductible. For this reason, contact your health insurance plan and your doctor for more specific information on the cost of non-HDL cholesterol testing.
Taking a Non-High-Density Lipoprotein Cholesterol Test
Non-HDL cholesterol tests are usually performed in a medical setting such as a doctor’s office, hospital, or health clinic. Laboratory testing involves a sample of blood taken from a vein that is sent to a lab, and point-of-care testing uses a fingerstick to rapidly analyze a drop of blood.
Before the test
Fasting may be required before a test of non-HDL cholesterol. Many doctors request that patients fast before cholesterol tests. Fasting is most common if the test includes an assessment of LDL cholesterol and triglycerides because these levels are more susceptible to change based on recent food consumption.
If the test is only measuring total cholesterol and HDL cholesterol so that non-HDL cholesterol can be calculated, fasting is not usually necessary.
If you fast, you will need to avoid consuming any food or beverages besides water for eight to 12 hours before the test. Many fasting blood tests are scheduled for the morning to make this fasting period easier.
Ask your doctor for specific instructions before cholesterol testing to make sure you know whether to fast or follow any other pretest preparations.
During the test
If you are having a needle blood draw, you will be seated during the test. A nurse or phlebotomist will usually wrap an elastic band above your elbow to maximize blood flow in your veins. They will disinfect an area of your skin and then insert a needle into the vein to withdraw a vial of blood.
This type of blood draw is routine and normally takes less than a few minutes. You may feel a sting during the test, but this pain is typically very brief.
If you are having a point-of-care test, your fingertip will be cleaned with an antiseptic wipe, and then the nurse or phlebotomist will prick your finger with a tiny needle. One or more drops of blood will be applied to a special test paper that is used for the analysis. Any pain from the finger prick is usually minor and short-lived.
After the test
Once a blood draw is complete, a bandage or swab is placed over the puncture site to prevent bleeding. Your arm may have some bruising or pain, but more serious side effects are rare. You can return to normal activity once the blood draw is complete.
If you had to fast for the test, it may be helpful to bring a snack so that you have something to eat immediately after the test is over.
For a point-of-care test, there are usually no side effects or activity restrictions after the test. If your fingertip is bleeding, you may be provided with a small bandage or cotton swab so that you can apply pressure to the puncture site.
Non-High-Density Lipoprotein Cholesterol Test Results
Receiving test results
Results from a laboratory cholesterol test with a needle blood draw are most often available within a few business days. You will normally be provided with a test report sent by mail or accessible through an electronic health portal. Your doctor may also call you or schedule an appointment to review the results.
Point-of-care tests provide rapid results, so if you have a fingerstick test, you will generally have results within a few minutes. The doctor or nurse who conducts the test may show you the result and/or review it with you.
Interpreting test results
Non-HDL cholesterol is usually listed in milligrams per deciliter (mg/dL) of blood or in millimole per liter (mmol/L). A cholesterol test report will show a separate line for each type of cholesterol that was assessed including total, HDL, and non-HDL cholesterol.
While some cholesterol test reports may not specifically list non-HDL cholesterol, the doctor can quickly calculate it by subtracting measured HDL cholesterol from total cholesterol. In some cases, the laboratory or your doctor may also calculate a ratio of total cholesterol to HDL cholesterol.
In addition to showing your levels, the test report will list the reference ranges for each type of cholesterol. This is important because it demonstrates what levels are considered to be normal for analyses done by that specific laboratory.
There is no single reference range for non-HDL cholesterol that is used for all people. Instead, interpretation of non-HDL cholesterol tests accounts for factors such as:
- Your sex
- Your age
- Your health history and overall health
- Your family health history, including relatives with cardiovascular disease
- Your lifestyle factors that can affect heart health, such as smoking
A review of these factors along with your cholesterol levels can help a doctor assess your risk of cardiovascular problems like coronary heart disease. Elevated levels of non-HDL cholesterol are associated with an increased risk of cardiovascular disease.
There are some factors that can affect the non-HDL cholesterol test results, including:
- Active illness: A current infection or illness may influence blood cholesterol levels.
- Variability among individuals and labs: Stress and other individual factors may contribute to slight changes in cholesterol test results. In addition, different laboratory methods can return small variations in cholesterol levels from lab to lab.
- Some blood disorders: Although uncommon, certain blood disorders can cause HDL levels to be lower than they actually are. This can impact the calculation of non-HDL cholesterol.
The best way to understand the significance of a cholesterol test is to discuss the result with a doctor. A doctor can review your levels of different types of cholesterol and address what those levels mean for your health. When appropriate, the doctor can also suggest specific steps to try to reduce your risk of cardiovascular disease. You may want to ask one or more of the following questions to your doctor:
- What kinds of cholesterol were measured on my test?
- Which, if any, cholesterol levels were abnormal?
- What other factors do you consider when determining my cardiovascular disease risk?
- Do you recommend any follow-up testing?
- Based on my non-HDL cholesterol levels, should I make any lifestyle changes or begin any treatment to improve my cardiovascular health?
