What Is Your Cholesterol Ratio?

Cholesterol levels are often used as a factor in estimating your risk of cardiovascular disease. When you get your cholesterol checked, your healthcare professional may look at several different results. One of these is your cholesterol ratio.

Cholesterol ratio is a comparison of your total cholesterol to your HDL cholesterol, which is then used as a tool to predict your risk of heart disease.

cholesterol and blood test results in laboratory.

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What Are the Types of Cholesterol?


Cholesterol is a waxy, fat-like substance found in the cells of the body. You need cholesterol in order to perform different functions in your body, however not all cholesterol is created equal.

High-density lipoprotein (HDL) cholesterol is considered the “good” type of cholesterol, while low-density lipoprotein (LDL) cholesterol is considered the “bad” type of cholesterol. Total cholesterol is a combined total measure of all the different types of cholesterol in your blood.

What Is a Cholesterol Ratio?

After HDL, LDL, and total cholesterol levels have been measured, the cholesterol ratio is then calculated. Your cholesterol ratio is calculated by dividing your total cholesterol by your HDL cholesterol. For example, if your total cholesterol is 180 and your HDL is 60, your cholesterol ratio is 3. 

Non-HDL Cholesterol vs. Cholesterol Ratio

Non-HDL cholesterol is the amount of HDL cholesterol subtracted from your total cholesterol. It includes LDL cholesterol and other types of cholesterol such as very-low-density lipoprotein—or VLDL—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. Some doctors now prefer using your non-HDL cholesterol level rather than your cholesterol ratio in determining heart disease risk.

However, it seems that both non-HDL cholesterol and cholesterol ratio appear to be better heart disease risk predictors than total cholesterol or LDL cholesterol levels alone.

What Is a Normal Ratio?

The optimal cholesterol ratio is between 3.5 and 1, while a ratio of 5 or below is considered normal. A cholesterol ratio within the normal range means that your cholesterol levels are likely not contributing to cardiac risk.

What Are the Risks of a High Ratio?

The higher your cholesterol ratio is, the greater your risk of heart disease. A high ratio is usually due to too high LDL and/or VLDL cholesterol, or low HDL cholesterol. Both the body and heart can be affected when cholesterol levels are not at normal levels. 

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, and it can even stop blood from getting to the heart altogether, increasing your risk of a heart attack or stroke.

How to Improve Your Cholesterol

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.

Medication

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.

Frequently Asked Questions

What is a good cholesterol ratio?

The optimal cholesterol ratio is between 3.5 and 1, while a ratio of 5 or below is considered normal.

What is cholesterol ratio?

Cholesterol ratio is a comparison of your total cholesterol to your HDL cholesterol, which is then used as a tool to predict your risk of heart disease.

How do you calculate cholesterol ratio?

Your cholesterol ratio is calculated by dividing your total cholesterol by your HDL cholesterol.

Summary

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 and 1.

A Word From Verywell

Cholesterol ratio is used as just one piece of information to determine your risk for heart disease. Your healthcare provider will take all of your cholesterol levels into account when determining your treatment plan, including any lifestyle changes and medication. Talk with your doctor if you have any questions or concerns.

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Article Sources
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  1. American Heart Association. What is cholesterol? Updated November 6, 2020.

  2. MedlinePlus. Cholesterol levels: What you need to know. Updated October 2, 2020.

  3. American Association of Clinical Chemistry. Non-high density lipoprotein cholesterol. Updated August 30, 2017.

  4. University of Rochester Medical Center. Lipid panel with total cholesterol: HDL ratio.

  5. Cleveland Clinic. Cholesterol guidelines and heart health. Updated May 24, 2019.

  6. Cleveland Clinic. Cholesterol numbers: what do they mean? Updated July 31, 2020.

  7. National Heart, Lung, and Blood Institute. Blood cholesterol.

  8. American Heart Association. American Heart Association recommendations for physical activity in adults and kids. Updated April 2018.

  9. National Heart, Lung, and Blood Institute. Smoking and your heart.