What Is Cholesterol Ratio and Why Does It Matter?
Learning Your Numbers
You skip breakfast, have a blood test, and get your cholesterol results a few days later. You’re probably familiar with your total cholesterol- that’s the number you want to keep below 200. Your total cholesterol is the sum of high-density lipoprotein, HDL (good cholesterol), plus low-density lipoprotein, LDL (bad cholesterol), plus 20 percent of your triglycerides, a type of fat carried in your blood. But what about your cholesterol ratio? Learn what this health statistic tells you.
What’s In a Ratio?
Your cholesterol ratio is calculated by dividing your total cholesterol by your HDL number. For instance, if your total cholesterol is 180 and your HDL is 82, your cholesterol ratio is 2.2. According to the American Heart Association (AHA), you should aim to keep your ratio below 5, with the ideal cholesterol ratio at 3.5.
Ratio and Risk for Men
According to Harvard Medical School, a cholesterol ratio of 5 indicates average risk of heart disease for men. Men run double the risk for heart disease if their ratio reaches 9.6 and have roughly half the average risk for heart disease with a cholesterol ratio of 3.4.
Ratio and Risk for Women
Because their HDL levels are often higher, women’s cholesterol ratio risk categories differ. For women, a 4.4 ratio indicates average risk for heart disease. Women’s heart disease risk doubles if their ratio is 7, while a ratio of 3.3 signifies roughly half the average risk.
Same Numbers, Different Ratio
Two people with the same total cholesterol number can have different cholesterol ratios. The ratios indicate different levels of heart disease risk. Harvard Medical School cites the following example: If your total cholesterol is 200 and your HDL is 60, your cholesterol ratio would be 3.3. That’s near the AHA ideal level. However, if your HDL is 35—below the recommended level of 40 for men and 50 for women—your cholesterol ratio would be 5.7. This ratio places you in a higher risk category.
Heart Health Shorthand
Some people may find it easier to remember their cholesterol ratio—one number—than their HDL, LDL, and total numbers. This is fine if you’re in a low-risk category, but if your bad cholesterol has climbed, it’s best to pay attention to all your numbers. Knowing your total cholesterol and the risk indicated by your cholesterol ratio helps you set the appropriate goals to keep your numbers in a healthy range.
Use the Numbers to Your Advantage
The AHA believes that absolute numbers for total blood cholesterol and HDL cholesterol—rather than a ratio—are more effective in determining cholesterol-lowering treatment. But both are useful in looking at your overall risk. If your total cholesterol level is high, your doctor will also look at the ratio of your total cholesterol to HDL. If that number is below 5, indicating average risk, your doctor may consider this in the overall evaluation of your risk.
Finding the Right Treatment
Your cholesterol ratio clarifies the picture of your risk of heart disease. But the ratio alone isn’t enough to assess what treatment will be best if your risk is high. Your doctor will take your total cholesterol into account to determine the correct mix of diet, exercise, and medication to bring your numbers into the desirable range.
- American Heart Association (2013). What your cholesterol levels mean. http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp
- Harvard Medical School (2005). Understanding cholesterol tests. http://www.health.harvard.edu/fhg/updates/update0205c.shtml
- Lemieux, I., Lamarche, B., Couillard, C., Pascot, A., Cantin, B., Bergeron, J., . . .& Despres, J. (2001). Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men. JAMA Internal Medicine, 161(22), 2685-2692. http://archinte.jamanetwork.com/article.aspx?articleid=752318
- Millan, J., Pinto, X., Munoz, A., Zuniga, M.,
Rubies-Prat, J., Pallardo, L., & Pedro-Botet, J. (2009). Lipoprotein ratios:
Physiological significance and clinical usefulness in cardiovascular
prevention. Vasc Health Risk Manag,