What does my cholesterol ratio mean?
The common ratio divides total cholesterol by HDL, the protective kind. Below about 4.5 is reassuring; lower is better. It packs two numbers into one signal of risk.
Doctors increasingly look at non-HDL cholesterol or ApoB as well, and at the whole picture: blood pressure, sugar, smoking, family history. A ratio is a clue, not a verdict.
Enter your panel into the calculator, then take the questions it raises to your own doctor rather than a supplement aisle.
Source: HEART UK, understanding your cholesterol test results
See a doctor promptly if
- Chest pressure, tightness or pain, especially with exertion, or spreading to the jaw, neck or arm, needs emergency assessment, not a cholesterol test
- Triglycerides above 500 mg/dL (5.6 mmol/L), and urgently above 880 mg/dL (10 mmol/L), because of the risk of acute pancreatitis
- LDL cholesterol of 190 mg/dL (4.9 mmol/L) or higher, which raises the possibility of familial hypercholesterolaemia
- Thickened tendons at the back of the ankle, raised yellow deposits around the eyelids, or a white ring around the cornea before age 45
- A parent or sibling who had a heart attack or stroke before age 55 in men or 65 in women
- New calf pain on walking that stops with rest, or sudden one-sided weakness or speech difficulty
Total cholesterol divided by HDL
| Result | In short | What it means |
|---|---|---|
| Under 3.5 | Very good | Either a low total or a high HDL, and usually both. Nothing in this number needs acting on. |
| 3.5 to 4.4 | Good | The range most people should be aiming for. Risk is decided more by blood pressure, smoking and blood sugar from here. |
| 4.5 to 5.4 | Worth a look | The point where a doctor starts looking at the whole picture rather than the ratio alone: LDL, non-HDL, family history and a risk score. |
| 5.5 to 6.9 | High | Usually a high total, a low HDL or both. Diet, movement and alcohol move it, and a formal cardiovascular risk estimate is the right next step. |
| 7.0 and above | See a doctor | High enough to warrant a proper assessment, including a check for inherited high cholesterol if it runs in the family. |
| Any ratio, with a very high LDL | The ratio is hiding it | A high HDL can flatter the ratio while LDL stays high. This is why non-HDL cholesterol and ApoB have largely replaced the ratio in guidelines. |
One result is a snapshot. Ranges differ a little between labs, and what a number means depends on the rest of you. Check it against the guidelines.
Work out what your cholesterol meansneeds a lab result, free, nothing to install
Look up another result
A result is rarely the only one on the page. Each of these gives the bands, in both unit systems, and what happens next.
- Albumin to creatinine ratio6 bands
- ALT result5 bands
- B12 result5 bands
- Bilirubin result6 bands
- Blood pressure reading8 bands
- Blood sugar targets, and how much age changes them6 bands
- Calcium result8 bands
- Cholesterol ratio6 bands
- Where your reading sits7 bands
- White cell count5 bands
- Why claims get denied, and the move for each7 bands
- Why they happen, and which ones matter6 bands
- Your resting pulse, counted sitting quietly6 bands
- Your training zones by age, in beats per minute8 bands
Answered by the AskDoc Medical Team · Medically reviewed under our Medical Director, MBBS · How we review
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