Is Your Chol/HDL Ratio High?

How it's calculated and what it means for your health

A high chol/HDL ratio is anything above 5 to 1—a result that puts you at higher risk for heart disease. This ratio is a comparison of the amount of total cholesterol and good cholesterol in your blood. It is one of several measurements healthcare providers use to estimate your risk of cardiovascular issues.

This article looks at cholesterol ratio, how it is calculated, and what it means for your health. It also discusses ways to improve your cholesterol levels.

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What Is a Cholesterol Ratio?

Your cholesterol ratio is a comparison of how much high-density lipoprotein (HDL, or "good" cholesterol) you have in your body compared to your total cholesterol level.

Total cholesterol is a measure of all cholesterol in your blood, including the main types:

  • High-density lipoprotein, which collects cholesterol and brings it to the liver so it can be removed
  • Low-density lipoprotein (LDL, or "bad" cholesterol), which increases your risk of heart disease and stroke when over 130 milligrams per deciliter (mg/dL)

While important, total cholesterol doesn't reveal as much about your cardiovascular risk as knowing why your level is what it is. Your total cholesterol could be high because LDL is more prevalent than HDL, which is harmful. But it could also be high because you have a lot of beneficial HDL.

Your cholesterol ratio helps shine a light on that.

How Your Chol/HDL Ratio Is Calculated

Before calculating your cholesterol ratio, your healthcare provider will need to order a lipid profile.

These blood tests help determine how much of each type of cholesterol you have in your bloodstream. They also reveal your level of triglycerides, a stored type of fat that can also increase heart disease risk.

The chol/HDL ratio is then determined by dividing your total cholesterol by your HDL level.

For example, if your total cholesterol is 180 and your HDL is 60, your cholesterol ratio is 3 to 1.

The higher the ratio, the higher the risk.

Non-HDL Cholesterol vs. Cholesterol Ratio

Non-HDL cholesterol is another way healthcare providers try to determine your risk of heart disease. It includes LDL cholesterol and other types of cholesterol such as very-low-density lipoprotein (VLDL), which plays a role in cholesterol build-up in the arteries.

To obtain this number, your HDL cholesterol is subtracted from your total cholesterol.

A normal level of non-HDL cholesterol for adults is less than 130 mg/dL. The higher the number, the higher your risk of heart disease.

Both non-HDL cholesterol and cholesterol-to-HDL ratio appear to be better heart disease risk predictors than total cholesterol or LDL cholesterol levels alone.

Some healthcare providers prefer non-HDL cholesterol, however. This is because non-HDL has a more linear relationship with your risk of heart disease. For example, as your non-HDL number goes up, your risk for heart disease goes up proportionally. This makes the number easier to interpret.

Cholesterol Ratio Ranges

Your cholesterol ratio can determine if you are at risk for heart disease and if so, how high your risk is.

  • Below 3.5 to 1: This ratio is considered optimal, putting you at very low risk for heart disease. Healthcare providers prefer to see cholesterol levels in this range, but it is not necessarily unhealthy for your levels to be slightly higher than this.
  • Between 3.5 and 5 to 1: This ratio is considered normal. A cholesterol ratio within the normal range means that your cholesterol levels put you at lower risk for heart disease.
  • Above 5 to 1: This results is considered high, putting you at elevated risk.

A high ratio is usually due to too high LDL and/or VLDL cholesterol, or low HDL cholesterol. A combination of factors play into this, such as eating a lot of saturated fat, not getting enough exercise, age, and more.

What Are the Risks of a High Cholesterol Ratio?

Too much LDL cholesterol in your blood can cause a type of heart disease called atherosclerosis.

This is a condition in which the flow of blood to the heart muscle is slowed. It can even stop blood from getting to the heart altogether, increasing your risk of a heart attack or stroke.

A 2019 study that looked at heart attack risk in women found that even people with "normal" ratios had an elevated risk of heart disease:

  • Women with a cholesterol ratio of between 3.5 and 4 to 1 were 14% more likely to have a heart attack.
  • Those with a ratio between 4 and 5 to 1 were 46% more likely to have a heart attack.
  • Those with a 5 to 1 and above ratio were 89% more likely to have a heart attack.

When your cholesterol is too high, you are at greater risk for having a heart attack or a stroke. High cholesterol can also contribute to other health problems like peripheral artery disease and high blood pressure.

How to Improve Your Cholesterol

If your cholesterol ratio comes back too high, there are things you can do to help improve your numbers. This includes lifestyle changes and medication.

Lifestyle Changes

If you want to improve your cholesterol levels, one of the best things you can do is to make lifestyle changes, such as with your diet and exercise.

Below are lifestyle habits you can change to help get cholesterol levels within normal ranges:

  • Eat a heart-healthy diet. A heart-healthy eating plan usually limits the amount of saturated and trans fats that you eat while including healthier unsaturated fats, along with plenty of fruits, vegetables, whole grains, and lean protein. Examples of heart-healthy eating patterns include the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the Therapeutic Lifestyle Changes (TLC) diet.
  • Maintain a healthy weight. High cholesterol levels can affect anyone, regardless of weight. However, having excess body weight is a risk factor for abnormal cholesterol levels. If you are overweight, losing even a modest amount of weight can help improve your cholesterol levels.
  • Participate in physical activity. It’s recommended for adults to engage in moderate-intensity physical activity at least 150 minutes per week, or about 30 minutes on most, if not all, days of the week.
  • Manage your stress levels. Studies have shown that chronic stress might lower your HDL cholesterol and raise your LDL cholesterol.
  • Quit smoking if you smoke. Smoking can increase your LDL cholesterol and decrease your HDL cholesterol. HDL cholesterol is considered “good” because it helps remove excess cholesterol from your tissues. Having more HDL can help lower your risk of heart disease.


If lifestyle changes alone are not enough to lower your cholesterol, you may also need to take cholesterol medication. Statins are the most common class of medications used to lower cholesterol. However, several different types of cholesterol-lowering medicines are available. 

The various medications work to lower cholesterol in different ways and can have different side effects. Do not stop taking your cholesterol medication if you feel a medication is not right for you. Always consult with your healthcare professional about stopping, changing, and/or finding the right medication for you.

In addition, don’t stop working to improve your lifestyle habits just because you are on cholesterol medicine. Cholesterol-lowering medications work best as you continue to implement heart-healthy lifestyle changes.


Cholesterol ratio may be one of the tests reported when your healthcare professional checks your risk for heart disease. It is calculated from total cholesterol and HDL cholesterol. A lower number indicates lower risk, with the optimal level being between 3.5 to 1.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Brittany Poulson, MDA, RDN, CD, CDCES
Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.