Cholesterol Ratios

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Cholesterol ratio

What is the cholesterol ratio? Calculate cholesterol ratios by dividing one by another cholesterol number. They are an important assessment tool for cardiovascular and other health risks.

Various studies show lipid ratios are better health risk predictor. Most used lipid ratios are TC/HDL ratio, and TG/HDL ratio.

Cholesterol Ratios to Predict Heart Disease

TC/HDL-C and LDL-C/HDL-C ratios are useful for the assessment of heart disease risk. The Framingham Heart study confirms these two ratios help assess heart-disease risk.

Different cholesterol ratios

TC/HDL cholesterol ratio

You can calculate TC/HDL ratio by dividing the total cholesterol by high-density lipoprotein cholesterol.

E.g. if TC is 200 mg/dL and HDL-C is 40 mg/dL; the ratio is 200/40 = 5.

High TC/HDL-C ratio is undesirable and increased your risk towards the heart attack. whereas, a low ratio indicates lower risk.

Women have higher HDL-C levels than men. Thus, the women’s ratio is lower compared to men.

  • Ideal: Less than 3.5 (in Men) < 3.0 (in Women)
  • Moderate: 3.5 to 5.0 (in Men) 3.0 to 4.4 (in Women)
  • High: More than 5.0 (in Men) > 4.4 (in Women)

TC/HDL-C ratio helps to predict the atherosclerosis risk. Cholesterol scientists divided on the use of cholesterol ratio for the heart risk prediction.

The Framingham Heart Study suggest a TC/HDL-C ratio of 9.6 (men) & 7 (women) doubled the average risk.

LDL/HDL cholesterol ratio

The LDL/HDL ratio calculated by dividing the LDL cholesterol by HDL cholesterol. E.g. if LDL-C is 125 mg/dL and HDL-C is 50 mg/dl; then the ratio is 125/50 = 2.5.

High LDL/HDL cholesterol ratio is undesirable and increased risk towards heart attacks. Whereas, a low ratio indicates lower risk.

  • Ideal: Less than 2.5
  • Moderate: 2.5 to 3.3
  • High: More than 3.3

Some use HDL/LDL ratio calculated by dividing the HDL cholesterol by LDL cholesterol. e.g. if HDL of 50 and LDL of 125, then HDL/LDL ratio is 0.4. Low HDL and high LDL lower the HDL/LDL ratio. The low ratio is undesirable and increased risk towards heart-attack.

  • Ideal: More than 0.4
  • Moderate: 0.4 to 0.3
  • High: Less than 0.3

Lipid scientists divided on the effectiveness of LDL/HDL or HDL/LDL ratio for heart risk prediction.

Most lipid profile test providers calculate the LDL (should measure). Thus, the ratio becomes less effective.

TG/HDL ratio

TG/HDL ratio calculated by dividing triglyceride by HDL cholesterol.

This ratio helps to predict whether the LDL is small dense or large fluffy. The small dense LDL is pattern B (more chance for small LDLs), considered as harmful. The large fluffy LDL is pattern A (more chance for large LDLs), considered as harmless.

A higher TG/HDL ratio indicates smaller LDL particles (pattern B - harmful). Whereas lower TG/HDL ratio indicates larger LDL particle (pattern A - harmless).

  • Ideal: Less than 3.5 (in Men) < 3.0 (in Women)
  • Moderate: 3.5 to 5.0 (in Men) 3.0 to 4.4 (in Women)
  • High: More than 5.0 (in Men) > 4.4 (in Women)

Fasting triglycerides, HDL, and risk of myocardial infarction published in Circulation, 1997; 96: 520-2525. The study shows the ratio of TG/HDL was a strong predictor of myocardial infarction.

High triglycerides and low HDL-C has an atherogenic link. High triglyceride in the VLDL generates small LDL during lipid exchange and lipolysis. These LDL particles accumulate in the blood circulation forming small HDL particles. This particles undergo accelerated catabolism completing the atherogenic circle.

High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease published in Clinics. Aug 2008; 63(4): 427–432. Already we know, TG/HDL-C is an indicator of coronary heart disease risk. This study indicates it is also related to the severity of vessel compromise.

The accuracy of the triglyceride/HDL-C ratio for prediction of the LDL phenotype B. This article published in American Journal of Cardiology, 2004 July 15;94(2):219-22.

The healthy fasting triglyceride should be below 150 mg/dl. The optimal HDL cholesterol should be over 40 mg/dl. Your TG/HDL-C ratio should be below 3.8. If the ratio is over 3.8, a greater chance for phenotype B (harmful small dense LDL). Otherwise, a greater chance for phenotype A (harmless large fluffy LDL).

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