Heart Health
Cholesterol / HDL Ratio
What This Marker Tells Us
Divides total cholesterol by HDL cholesterol, providing a simple cardiovascular risk indicator that captures the balance between total cholesterol load and protective HDL.
Why It Matters
Historically popular because it integrates total cholesterol burden with HDL protection in one number. Lower ratios indicate better cardiovascular risk profiles; high HDL relative to total cholesterol is protective. The ratio helps identify people with "normal" total cholesterol who have low HDL (higher risk) versus those with "high" total cholesterol driven by very high HDL (lower risk). Optimal ratio is below 3.5, with ratios below 3.0 indicating excellent cardiovascular health. Ratios above 5.0 indicate high risk. However, this ratio has limitations: it doesn't account for triglycerides or LDL particle size. The triglyceride/HDL ratio and non-HDL cholesterol are increasingly preferred markers, though cholesterol/HDL ratio remains useful for quick risk assessment.
How to Interpret Your Trends
Low ratios (below 3.5) indicate excellent cardiovascular protection with robust HDL activity. Typical ratios (3.5-5.0) suggest average risk requiring attention to other factors. High ratios (above 5.0) signal significantly increased cardiovascular risk from either elevated total cholesterol, low HDL, or both. Context from LDL particle number, inflammation, and metabolic health refines risk assessment.
What Influences This Marker
Exercise consistently raises HDL, improving the ratio. Trans fats, excess refined carbohydrates, and obesity lower HDL while raising total cholesterol. Smoking, sedentary lifestyle, and metabolic syndrome worsen the ratio. Mediterranean diet patterns, healthy fats, weight loss, and regular aerobic exercise optimize this balance. Genetics influence baseline HDL levels significantly.
How Your Team Uses It
Your team uses this ratio to guide cardiovascular risk reduction strategies, prioritizing interventions based on which component is problematic. Low HDL prompts exercise intensity increases and healthy fat recommendations. High total cholesterol guides dietary saturated fat reduction and considers additional testing. Ratio improvements track intervention success.
Related Signals We Also Review
Total cholesterol, HDL, LDL, triglycerides, ApoB, LDL particle number, inflammatory markers, and metabolic health indicators complete cardiovascular risk assessment.