Cholesterol Ratio

A cholesterol ratio shows the balance between good and bad cholesterol levels in your body. Maintaining ideal levels can be useful in reducing your chances of developing heart disease later in life. But to understand what your cholesterol ratio means, you need to know the difference between good and bad cholesterol and what levels are recommended for you.

Cholesterol: The good and the bad

A total blood cholesterol reading tells you how much good and bad cholesterol you have in your body. The bad cholesterol, called low density lipoproteins or LDLs, travels through your blood stream and can clog your arteries, increasing your risk of heart disease and stroke. The good cholesterol, called high density lipoproteins or HDLs, helps carry the excess LDLs from your arteries to your liver where it can be disposed of. It's the good cholesterol, or HDLs, that is used to determine your cholesterol ratio.

What are the ideal cholesterol levels?

In general, a total blood cholesterol level of under 200mg/dL is desirable. Your LDL levels should be under 130mg/dL (under 100mg/dL being optimal) and your HDL levels should be at least 60mg/dL. The risk for heart disease increases when HDL levels are below 40mg/dL for a man and below 50mg/dL for a woman. When women enter menopause, their HDLs decrease and their LDLs increase, putting them at greater risk for developing heart disease. So pre-menopausal women should strive to keep their good and bad cholesterol at optimal levels. People with diabetes and hypertension are more prone to developing heart disease, so they should try to keep their LDL levels under 70 mg/dL.

How do you determine your cholesterol ratio?

Before calculating your cholesterol ratio, you need to know your levels. Ask your doctor to schedule you for a fasting blood lipoprotein profile. You cannot eat or drink anything for 12 hours before this blood test to ensure the most accurate results. To determine your cholesterol ratio, divide your total blood cholesterol level by your HDL. So if your total cholesterol level is 200mg/dL and your HDL is 50mg/dL, your cholesterol ratio is 4:1 (200/50=4.) The American Heart Association recommends keeping your cholesterol ratio under 5:1 with 3.5:1 being ideal.

Benefits of knowing and maintaining a healthy cholesterol ratio

Maintaining an ideal cholesterol ratio helps reduce your risk of developing heart disease. Some of the things you can do to keep optimal cholesterol levels include eating a low saturated fat/high fiber diet and exercising regularly 5-6 times a week. If you smoke, give it up. Quitting smoking can actually raise your HDLs and lower your LDLs. If high cholesterol is a genetic or hereditary problem, speak with your health care provider about additional treatments that may include taking medications. 

Reviewed by Dr. Jennifer Monti, MD, MPH