The New and Improved Cholesterol Ratio

In the past, doctors have focused on the ratio of our good cholesterol (HDL) to our total cholesterol but, in today’s medical community, there is growing consensus that a closer look at bad cholesterol (LDL) is our best management tool.

Total Cholesterol contains good cholesterol that protects our heart, known as High Density Lipoprotein (HDL) and bad cholesterol that is harmful to the heart, known as Low-Density Lipoprotein (LDL).

Cholesterol, although a fat, is an essential nutrient for the body. It is made in the liver. The liver produces cholesterol in the necessary quantities for a healthy body, then revs up its production when we ingest a diet high in saturated fats and foods such as meats, dairy products and eggs. When the liver cannot efficiently dispose of the cholesterol excesses of a high fat diet, the excess cholesterol becomes bad cholesterol (LDL) and travels to the arteries of the heart and deposits itself there in the form of plaque. As the plaque accumulates, the walls of the arteries narrow and blood flow to the heart is restricted and eventually blocked.

The theory that “a higher ratio of something good to something bad is always better” is especially true for a healthy heart. This new standard compares our bad cholesterol (LDL) to our good cholesterol (HDL), rather than our good cholesterol to our total cholesterol.

Here are two examples, both using the same method, of how to arrive at the ratio of your bad cholesterol (LDL) to your good cholesterol (HDL):

  • LDL of 129 divided by HDL of 40 = a ratio of 3.2
  • LDL of 99 divided by HDL of 60 = a ratio of 1.7

The first ratio example of 3.2 indicates the lesser risk of having a heart attack or stroke as compared to the higher risks of up to 11.0. The lower the ratio the better. In general, a ratio of 3.5 or below is recommended.

The second ratio of 1.7 represents the recommended guidelines for optimal, or the best, levels of good and bad cholesterol, which is below 100 for LDL and above 59 for HDL. A ratio of 1.7 or any ratio below 3.3 is considered even better than a low risk.

Risk levels for heart attach or stroke due to blocked arteries:

  • Considered a Low Risk: 3.3 to 4.4
  • Considered an Average Risk: 4.4 to 7.1
  • Considered a Moderate Risk: 7.1 to 11.0
  • Considered a High Risk: 11.0

Consider these three questions:

  • Is your blood pressure above healthy levels?
  • Do you smoke cigarettes?
  • Do you have a family history of heart disease?

If your answer is “yes” to any of the above, you may have additional risk factors for heart disease, even if your cholesterol risk-ratio is at optimal levels. While you can do nothing about family history, general medical advice urges us to get control of high blood pressure and quit smoking.

If you do not know your cholesterol numbers: total cholesterol, HDL and LDL, make an appointment to discuss your cholesterol ratios with your doctor and request a copy of your lab report for your files. Your physician’s analysis is your best guide to cholesterol management.

Comments 5
  1. In 10 years it might be nice to know just how "new" this improved guide is/was. Please put a date that is prominent. Right now it may have been written in 1997 as far as I can tell.

  2. I have just had my blood test results given to me over the phone by my gp surgery in the 'ratio format for the first time. I was told that my cholesterol was 367 my HDL was 147 and my ratio was 2.5. When I asked what that meant (as I have only ever been given HDL & LDL figures before, the response was "I don't know, they keep changing the systems" which wasn't really helpful. I found this article via Google and I now realise what it means and that I am not in any great danger of imminent death!) so thank you very much for posting it.

  3. You state a diet high in saturated fats, eg eggs, dairy, meats etc causes high cholesterol. This is not correct. I have a diet high in fats, esp saturated, full cream milk, lots of eggs, butter, meats, and veggies, fruit and some chocolate and treats, yet my total cholesterol is 193, HDL is 126, LDL is 62 and triglycerides are 35. There are studies showing the same, a diet high in processed surgery food causes high cholesterol and deranged lipids, real foods (eggs, cream, meat) are good for us.

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