Cholesterol to hdl ratio

HDL Cholesterol

Sources Used in Current Review

Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934.

Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Daly Jr DD, DePalma SM, Minissian MB, Orringer CE, Smith SC. 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2016. Available as pdf at

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA .

Pagana K, Pagana T. Mosby’s Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006. pp 351-355.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC. Pp 252-253.

Ken-ichi Hirano, et al. Atherosclerotic Disease in Marked Hyperalphalipoproteinemia: Combined Reduction of Cholesteryl Ester Transfer Protein and Hepatic Triglyceride Lipase. Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15:1849-1856. Available online at;15/11/1849?eaf. Accessed May 2010.

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Sep 2002. PDF available for download at Accessed July 21, 2013.

(December 2011) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics. December 2011. Vol 128. Supplement 5. PDF available for download at Accessed July 21, 2013.

The ratio of total cholesterol to HDL is an easy way to get an idea of whether your cholesterol levels are healthy.

If you can achieve a healthy ratio of total cholesterol to HDL, and maintain this long-term, this can help to reduce your risk of heart problems in the future.

Using the calculator

To use the calculator, you will only need your total cholesterol figure and your HDL figure.

If you do not have either or both of these, ask your health team. People with diabetes in the UK should have total and HDL cholesterol measured at least once each year.

A ratio of under 4 is usually regarded as a sign of healthy cholesterol levels.

Note that, whilst there is no official figure to aim for it is understood that the lower the figure, the healthier your cholesterol levels are.

The cholesterol charity Heart UK states that a figure above 6 is regarded as representing a high risk of heart disease.

Calculate your cholesterol ratio

If you live in the UK, you will normally be given your cholesterol results in mmol/l.

Note that the calculator is only meant to serve as a guide.

If you have any questions your cholesterol levels, please discuss these questions with your health team.

Total cholesterol to HDL (mmol/l) Total cholesterol (mmol/l) HDL cholesterol (mmol/l) Calculate

Cholesterol Levels: What You Need to Know

What is cholesterol?

Cholesterol is a waxy, fat-like substance that’s found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But if you have too much cholesterol in your blood, you have a higher risk of coronary artery disease.

How do you measure cholesterol levels?

A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you’ll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your

  • Total cholesterol – a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
  • LDL (bad) cholesterol – the main source of cholesterol buildup and blockage in the arteries
  • HDL (good) cholesterol – HDL helps remove cholesterol from your arteries
  • Non-HDL – this number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
  • Triglycerides – another form of fat in your blood that can raise your risk for heart disease, especially in women

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Here are the healthy levels of cholesterol, based on your age and gender:

Anyone age 19 or younger:

Type of Cholesterol Healthy Level
Total Cholesterol Less than 170mg/dL
Non-HDL Less than 120mg/dL
LDL Less than 100mg/dL
HDL More than 45mg/dL

Men age 20 or older:

Type of Cholesterol Healthy Level
Total Cholesterol 125 to 200mg/dL
Non-HDL Less than 130mg/dL
LDL Less than 100mg/dL
HDL 40mg/dL or higher

Women age 20 or older:

Type of Cholesterol Healthy Level
Total Cholesterol 125 to 200mg/dL
Non-HDL Less than 130mg/dL
LDL Less than 100mg/dL
HDL 50mg/dL or higher

Triglycerides are not a type of cholesterol, but they are part of a lipoprotein panel (the test that measures cholesterol levels). A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

How often should I get a cholesterol test?

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

  • The first test should be between ages 9 to 11
  • Children should have the test again every 5 years
  • Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older:

  • Younger adults should have the test every 5 years
  • Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What affects my cholesterol levels?

A variety of things can affect cholesterol levels. These are some things you can do to lower your cholesterol levels:

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
  • Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL (bad) cholesterol, total cholesterol, and triglyceride levels. It also raises your HDL (good) cholesterol level.
  • Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.
  • Smoking. Cigarette smoking lowers your HDL (good) cholesterol. HDL helps to remove bad cholesterol from your arteries. So a lower HDL can contribute to a higher level of bad cholesterol.

Things outside of your control that can also affect cholesterol levels include:

  • Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women’s LDL (bad) cholesterol levels tend to rise.
  • Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
  • Race. Certain races may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than whites.

How can I lower my cholesterol?

There are two main ways to lower your cholesterol:

  • Heart-healthy lifestyle changes, which include:
    • Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples include the Therapeutic Lifestyle Changes diet and the DASH Eating Plan.
    • Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol.
    • Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
    • Managing stress. Research has shown that chronic stress can sometimes raise your LDL cholesterol and lower your HDL cholesterol.
    • Quitting smoking. Quitting smoking can raise your HDL cholesterol. Since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol.
  • Drug Treatment. If lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol medicines available, including statins. The medicines work in different ways and can have different side effects. Talk to your health care provider about which one is right for you. While you are taking medicines to lower your cholesterol, you should continue with the lifestyle changes.

NIH: National Heart, Lung, and Blood Institute

Cholesterol Ratio Calculator

Total cholesterol, HDL, LDL, and triglycerides

Our cholesterol ratio calculator takes into account four basic blood test results. All recommended levels are according to the National Heart, Lung, and Blood Institute within the National Institutes of Health.

You only need to input three of your results – they are dependent on each other according to the formula:

total cholesterol = HDL + LDL + 0.2 * triglycerides

  1. Total cholesterol is just an overview of your cholesterol level. It might be misleading, as it combines the levels of good and bad cholesterol in your blood, and does not give sufficient information about heart disease risks.
  • Desirable: Less than 200 mg/dL
  • Borderline high: 200 – 239 mg/dL
  • High: 240 mg/dL and above
  1. HDL (High-density lipoprotein) is the “good” cholesterol in your blood. Generally speaking, it is a form of cholesterol which is transfered from other parts of your body to the liver in order to metabolize it and remove from the body with bile acids. That’s why this is the only cholesterol type that should be kept high. Women tend to have slightly higher HDL levels than men.

  • Optimal: 60 mg/dL and above
  • Borderline: 40 – 59 mg/dL
  • Risk of heart disease: Less than 40 mg/dL
  1. LDL (Low-density lipoprotein) is the “bad” cholesterol that accumulates in your arteries and can cause serious medical conditions, such as heart strokes. The lower the LDL level, the better. Remember that if your LDL level is high, you should consult a doctor to investigate risk factors that can lead to heart diseases. Use our LDL calculator to estimate its value based on total cholesterol, HDL and triglyceride levels.
  1. Triglycerides are not actually cholesterol, but a type of fat transported within your blood. Most of the triglycerides in your body are stored as body fat. Still, high triglyceride levels may be a sign of a lipoprotein problem, as other symptoms such as diabetes often accompany it.
  • Normal: Less than 150 mg/dL
  • Borderline high: 150 – 199 mg/dL
  • High: 200 – 499 mg/dL
  • Very high: 500 mg/dL or above

It is also crucial to know that desirable values of different cholesterol fractions may differ regarding the patient and his/her cardiovascular risk! To ensure yourself about your results don’t hesitate to consult it with your doctor!

Total Cholesterol to HDL Ratio

I just got cholesterol test results and the TC/HDL ratio is 3.5. What is the risk factor and what does the number mean?

– Kathi, Oregon

I’m glad you asked this question since deciphering your results can be confusing. The total cholesterol to HDL cholesterol ratio is a number that is helpful in predicting atherosclerosis, the process of fatty buildup in the walls of the arteries. The number is obtained by dividing total cholesterol by HDL (good) cholesterol. For example, if a person has a total cholesterol of 200 mg/dL and an HDL cholesterol level of 50 mg/dL, the ratio would be 4.0. A high ratio indicates a higher risk of heart attack while a low ratio indicates a lower risk. High total cholesterol (an indicator that your body has a lot of the lipoproteins that contribute to atherosclerosis) and low HDL cholesterol increases the ratio, so that scenario is undesirable. Conversely, low total cholesterol and high HDL cholesterol lowers the ratio and is good news.

The goal is to keep the ratio below 5.0; the optimum ratio is 3.5. But even though this ratio can be a powerful predictor of heart disease risk, it is not used as a sole indicator for therapy. So while this ratio will help you understand your risk, keep in mind that your physician will be making treatment choices based upon your other lipoprotein numbers, specifically your LDL and HDL levels.

What is cholesterol ratio and why is it important?

Share on PinterestA doctor can determine the levels of “good” and “bad” cholesterol in the body using a blood test.

Total cholesterol levels are made up of three different types of cholesterol.

High-density lipoprotein, or HDL, is considered “good” cholesterol. It makes up 20-30 percent of a person’s total cholesterol level.

Low-density lipoprotein, or LDL, is considered “bad” cholesterol and makes up 60-70 percent of the total in the body.

Finally, very-low-density lipoprotein (VLDL) is a precursor to LDL and makes up about 10-15 percent of a person’s total cholesterol.

These percentages matter because when increases or decreases occur, they can affect the chances of a person developing heart disease.

When a person has a test that shows a high total cholesterol level, it may be because LDL cholesterol levels have climbed. A doctor can determine the different levels of cholesterol by focusing on HDL, LDL, and VLDL separately, in a blood test.

A good cholesterol ratio shows that the body is working properly and is healthy. It signals that someone is in good health and is probably taking care of themselves.

The Framingham Heart Study states that the following cholesterol ratios roughly signal different degrees of heart disease risk:


  • 5.0 = average risk
  • 3.4 = half the average risk
  • 9.6 = twice the average risk


  • 4.4 = average risk
  • 3.3 = half the average risk
  • 7.0 = twice the average risk

While men and women have the same blood test, their average HDL, LDL, and VLDL levels are typically different. For example, in the case of menopausal women, it is usual for them to have an increased LDL.

This does not mean that women are unaffected by bad cholesterol ratios. It simply means women have shown to be less susceptible to bad cholesterol ratios.

Women should have a recommended HDL level of 50, while a man’s recommended HDL level is 40.

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Topic: Heart Attack Prevention

Dr. Lee:
What is total cholesterol to HDL cholesterol ratio? What is a desirable ratio?

Dr. Gregory Thomas:

The total cholesterol to HDL cholesterol ratio is a number that is helpful in predicting an individual’s risk of developing atherosclerosis. The number is obtained by dividing the total cholesterol value by the value of the HDL cholesterol. (High ratios indicate higher risks of heart attacks, low ratios indicate lower risk).

High total cholesterol and low HDL cholesterol increases the ratio, and is undesirable. Conversely, high HDL cholesterol and low total cholesterol lowers the ratio, and is desirable.

An average ratio would be about 4.5. Ideally we want to be better than average if we can. Thus the best ratio would be 2 or 3, or less than 4.

Another ratio is LDL/HDL. The LDL/HDL ratio is actually a purer ratio than total cholesterol/HDL, because LDL is a measure of “bad’ cholesterol and HDL is a measure of “good” cholesterol, whereas the total cholesterol is the sum of HDL, LDL, and the VLDL. Adding up the values for the HDL, LDL and VLDL makes up the total cholesterol measurement.

Even though the total cholesterol/HDL ratio is not as accurate or pure as the LDL/HDL ratio, the former is more commonly obtained because the total cholesterol is easier and cheaper to obtain than the LDL cholesterol level.

It is important to remember that even with a favorable ratio; we have learned that it is still important to try to obtain an LDL of less than 80-100, regardless of the HDL value, especially in the presence of multiple other risk factors for coronary artery disease (genetic predisposition, tobacco use, hypertension, and diabetes). In patients with known coronary artery disease (history of bypass surgery, stents, or PTCA), an LDL of less than 80 is extremely desirable.

Revising Medical Author: Daniel Kulick, MD, FACC, FSCAI
Revising Medical Editor: Melissa Conrad Stöppler, MD


Understanding Cholesterol

Here’s what you need to know about HDLs, LDLs, and all those confusing numbers.

Back To Basics

Despite the negative connotation attached to it, cholesterol is essential to your life. It’s the primary element of the membrane that surrounds every cell in your body—without cholesterol, your body won’t synthesize vitamin D, bile acids, or steroid hormones. Cholesterol is found in all animal tissues—cheese, butter, rib-eye steaks, chicken tenders, you name it. It isn’t found, however, in any plant tissues, which is why vegetable oil is labeled “cholesterol-free.”

To reach every cell in your body, cholesterol travels in the bloodstream. It’s a waxy, fat-like substance formed in the liver that won’t dissolve in blood. Instead, it’s carried along by lipoproteins, tidy combinations of fat and protein that can take on cargo and sail through the bloodstream.

Low-density lipoproteins (LDLs) carry cholesterol out from the liver to all the cells. The LDLs dock and offload the cholesterol cargo at cell receptor sites. But the cells are only going to take so much—they have their limits, after all.

Excess cholesterol continues to travel around in the blood. The extra LDL packaging and the cholesterol can snag in the artery walls and contribute to the buildup of plaque. Excessively high levels of LDLs can contribute to atherosclerosis, or hardening of the arteries. The greatest contributor to high cholesterol levels is the cholesterol made in the liver from the fat we eat—particularly saturated fat.

High-density lipoproteins (HDLs) gather up and return unused cholesterol to the liver, where it’s removed from the blood and excreted from the body. HDLs work against hardening of the arteries, which is why they are often called “good” cholesterol.

Healthy eating habits (those involving with less dietary fat and cholesterol) and regular exercise help increase the amount of HDLs in your blood and reduce the amount of LDLs. Smoking, on the other hand, reduces desirable HDLs. Your total cholesterol level is measured from a blood sample as milligrams of total cholesterol per deciliter of blood (mg/dl). A total cholesterol reading of 200 mg/dl or lower is good; a reading of 240 mg/dl or higher needs attention because it is approaching an unhealthy level.

The Benefits Of A Healthy Diet And Regular Exercise

High blood cholesterol can contribute to coronary heart disease, but by itself doesn’t cause it. While high blood cholesterol is a risk factor for coronary heart disease, it is merely one of several risk factors, and they should all be considered together, case by case.

If you were a man over 60 with a family history of heart disease, if you didn’t exercise, if you smoked and were overweight, and if your cholesterol reading was on the high side, you might be looking at a heart attack in the next five years. Treatment shouldn’t just focus on bringing down high cholesterol; it should be aimed at reducing all the risk factors you can control—smoking, diet, exercise, etc.

Isn’t There A Pill Or Something?

While there are, in fact, new medications to lower cholesterol, they are used as a last resort. If there’s a high probability of heart attack in the next five years due to your risk factors—and your cholesterol is high—then medication is a route worth exploring. But that’s something to work out with your doctor, and only then after you’ve tried bringing your cholesterol down by other means.

How To Bring Down Your Cholesterol

You can often lower your cholesterol by making a few lifestyle adjustments. Here’s how:

  • If you smoke, stop right now. If you don’t smoke, don’t start. Smoking reduces HDLs, the “good” cholesterol that you want to be as high as possible.
  • Exercise regularly. Exercise reduces LDLs, the “bad” cholesterol, and increases HDLs, the good cholesterol.
  • Drink alcohol in moderation.
  • Reduce the fat intake in your diet.
  • Reduce the stress in your life.
  • If you are overweight, try to lose those extra pounds.

Everything you do to reduce cholesterol helps you lose weight and lower blood pressure. Everything you do to lower blood cholesterol is good for your heart, helps prevent colon cancer, and benefits you as you grow older.

Men between 40 and 65 should have their cholesterol checked, and then consider a test every five years if all cholesterol levels are desirable and they are not at high risk for heart disease. Women between 50 and 65 should consider having their cholesterol checked, and then tested again in five-year intervals if all cholesterol levels are desirable and they are not at high risk for heart disease. Cholesterol screening is most important for people at high risk for heart disease.

Have More Questions?

If you have questions after this examination is completed, ask your personal physician.

What Do The Cholesterol Numbers Mean?

The most commonly used cholesterol values are listed below. The rule of thumb: You want HDL to be high, while LDL should be low.

Desirable—All of the following:

Total cholesterol below 200.
HDL cholesterol above 35. LDL cholesterol below 130.
Total-to-HDL ratio below 3.5 to 1.
LDL-to-HDL ratio lower than 3 to 1.

Borderline High-Risk—One or more of the following:
Total cholesterol level of 200 to 239.
LDL cholesterol level of 130 to159.
Total-to-HDL ratio of 3.5 to 4.5 to 1.

High-Risk—One or more of the following:
Total cholesterol level of 240 or higher.
HDL cholesterol below 35.
Total to HDL ratio of 4.5 to 1 or higher.
LDL or HDL ratio of 3 to 1 or higher.

The Low Cholesterol Diet

Fats should make up no more than 30 percent of the calories you eat in a day, according to the American Heart Association. To make a more significant reduction in the amount of fat in your diet, aim for 20-25 percent.

Keep saturated fats to a minimum. They are found in animal products (meat, fish, poultry, eggs, butter, cheese) and in tropical oils (used in snack foods and baked goods).

Monounsaturated fats (olive oil, canola oil) can lower LDLs.


How important is cholesterol ratio and non-HDL cholesterol?


For predicting your risk of heart disease, many doctors now believe that determining your non-HDL cholesterol level may be more useful than calculating your cholesterol ratio. And either option appears to be a better risk predictor than your total cholesterol level or even your low-density lipoprotein (LDL, or “bad”) cholesterol level.

Non-HDL cholesterol, as its name implies, simply subtracts your high-density lipoprotein (HDL, or “good”) cholesterol number from your total cholesterol number. So it contains all the “bad” types of cholesterol.

An optimal level of non-HDL cholesterol is less than 130 milligrams per deciliter (mg/dL), or 3.37 millimoles per liter (mmol/L). Higher numbers mean a higher risk of heart disease.

To calculate your cholesterol ratio, divide your total cholesterol number by your HDL cholesterol number. So if your total cholesterol is 200 mg/dL (5.2 mmol/L) and your HDL is 50 mg/dL (1.3 mmol/L), your ratio would be 4-to-1. Higher ratios mean a higher risk of heart disease.

Last Updated: 02-20-2018 FAQ-20058006

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