What is a cholesterol ratio

What does your cholesterol ratio mean?

Your body needs cholesterol to work properly. But having too much of certain types of cholesterol in your blood can contribute to fatty build-up inside your arteries, increasing your risk of a heart attack or stroke.

A cholesterol test may measure:

• Total cholesterol: the overall amount of cholesterol in your blood.
• HDL cholesterol: sometimes called “good” cholesterol because it helps carry cholesterol away from the arteries and back to the liver.
• Non-HDL cholesterol: includes the types of cholesterol that can contribute to fatty build-up in the arteries.
• Triglycerides: another type of fat found in the blood.
• Your cholesterol ratio: compares your total cholesterol with your HDL cholesterol.

Non-HDL cholesterol is now an important measure because it includes LDL and other types of cholesterol that may contribute to fatty build-up in the arteries. nhs.uk, bhf.org.uk, heartuk.org.uk

How is your cholesterol ratio calculated?

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

For example:

Total cholesterol of 5 mmol/L ÷ HDL cholesterol of 1.25 mmol/L = a cholesterol ratio of 4

You may see it written on your results as:

• TC:HDL ratio
• Total cholesterol-to-HDL ratio
• Cholesterol/HDL ratio

Generally, a lower ratio is better, however your ratio should always be considered alongside your non-HDL cholesterol, HDL cholesterol, triglycerides and overall health.

What is a healthy cholesterol ratio?

There is no single ratio that tells you whether your heart is healthy.

Your cholesterol ratio is primarily used alongside information such as your age, blood pressure, smoking status, ethnic background and health conditions to estimate your overall risk of heart and circulatory disease. A healthcare professional may use these details to calculate your QRISK score, which estimates your risk over the next 10 years. nhs.uk, nice.org.uk

It is important not to rely on the ratio alone. A result can sometimes look reassuring because HDL cholesterol is high, even if non-HDL or LDL cholesterol is also higher than recommended. heartuk.org.uk

Ask your GP, nurse or pharmacist to talk you through all the numbers in your cholesterol result.

What are healthy cholesterol levels?

As a general guide for healthy adults, the recommends:

• Total cholesterol: below 5 mmol/L
• Non-HDL cholesterol: below 4 mmol/L
• HDL cholesterol: above 1.0 mmol/L for men and above 1.2 mmol/L for women

These are general guides rather than targets for everyone. Your personal target may be different if you have heart disease, diabetes or another health condition, or if you are taking cholesterol-lowering medicine. nhs.uk, bhf.org.uk

How do I get my cholesterol tested?

A cholesterol test can be carried out using blood taken from your arm or, in some settings, a finger-prick test.

High cholesterol does not usually cause symptoms, so having a test is the only way to know your levels. Anyone can have high cholesterol, even if they are young, active or a healthy weight. heartuk.org.uk, bhf.org.uk

Speak to your GP, nurse or pharmacist if you are concerned about your cholesterol, particularly if:

• High cholesterol or early heart disease runs in your family
• You have high blood pressure or diabetes
• You smoke
• You have previously had a high cholesterol result
• You would like to understand your heart health better

What if my cholesterol results are higher than recommended?

Try not to worry. A higher result does not mean that you have heart disease.

Your healthcare professional will consider your complete cholesterol result alongside your wider health. They can explain whether you need to make any changes or have further checks.

Depending on your personal risk, they may recommend changes to your diet and activity levels, support to stop smoking, cholesterol-lowering medicine or a follow-up test.

Small, manageable changes can help support healthy cholesterol levels. Explore our advice on how to lower cholesterol or download our Cholesterol Lowering Starter Kit for practical tips and food-swap ideas.

Disclaimer

This information is for general educational purposes and is not a substitute for personalised medical advice. If you have questions about your cholesterol results or your health, speak to your GP or another qualified healthcare professional.