Cholesterol ratios

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Cholesterol ratios

Research has shown that cholesterol ratios can be more useful for predicting risk of heart disease compared to single cholesterol numbers. This is because individual values don’t show us the ‘whole picture’.

Total cholesterol to HDL cholesterol ratio

The total cholesterol HDL ratio (Total / HDL) is calculated by dividing total cholesterol by HDL cholesterol. i.e.

Total cholesterol/HDL Ratio = [Total Cholesterol/HDl Cholesterol]
The American Heart Association suggests that it is desirable for the ratio to be 5:1 or under, and that an optimum total/HDL cholesterol ratio is 3.5:1.

A high ratio is undesirable, as it is indicates a higher risk of heart disease. Low ratios are ideal as they predict a lower risk of heart disease.

A low HDL cholesterol and high total cholesterol value increases the total/HDL cholesterol ratio.

The flip side of that is that a low total cholesterol value and a high HDL cholesterol reduces the ratio, which is certainly what we should aim for.

LDL/HDL ratio

The LDL/HDL Ratio is calculated by dividing the LDL cholesterol value by the HDL cholesterol value. i.e.

LDL/HDL ratio = [LDL Cholesterol / HDL Cholesterol]
Many health professionals consider the LDL/HDL ratio to be more useful than the total/HDL ratio, simply because it is a more direct ratio. In other words, the LDL/HDL ratio is a pure comparison of your “good” cholesterol to “bad” cholesterol.

Keep in mind that total cholesterol is a combination of VLDL, HDL and LDL.

Some examples

Person A

Suppose person A has a low HDL. It could be said that they are at a higher risk of heart disease because of this. But if they also had an extremely low LDL level, then it figures that their LDL/HDL ratio will also be relatively low.

So person A’s risk of heart disease doesn’t seem quite as extreme now. And despite the low HDL, a very low LDL would also mean that the total cholesterol/HDL ratio would possibly still be within recommendations.

Person B

Suppose person B has a low HDL and a high LDL, much higher than the recommendations.

Using both the LDL/HDL ratio and total cholesterol/HDL ratio, we can determine that person B has a much greater risk of heart disease because both ratios would be much higher due to the elevated levels of LDL.

In this manner, cholesterol ratio’s can be more insightful for assessing a person’s cholesterol profile and resulting heart disease risk.

Some medical authors believe that the total cholesterol/HDL ratio is more predictive of heart disease risk than TC (total cholesterol) alone. And it makes sense that this is the case! Looking at total cholesterol gives us no information about the breakdown of the types of cholesterol that make up the total cholesterol. Lets look at another example.

Persons C and D

Person C has a total cholesterol of 6.7 mmol/L or 259 mg/dL. Person D also has a total cholesterol of 6.7 mmol/L or 259 mg/dL.

From this value alone, we cannot tell who has the greater risk of heart disease. Suppose we find out that person C has a total cholesterol/HDL ratio of 4:1, and person D has a ratio of 5.5:1.

Comparing the 2 ratio’s, we can determine that person C has a lower risk of heart disease due to a higher HDL percentage and lower total/HDL ratio.

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