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Cholesterol ratio

What is cholesterol ratio

The cholesterol ratio is used to describe your ratio of total cholesterol to the amount of high-density lipoprotein cholesterol (HDL-cholesterol, often called “good cholesterol”).

As well as your total cholesterol level, your cholesterol ratio is another measurement that may help to tell you more about whether you need to take steps towards a healthier diet and lifestyle.

Why does your cholesterol ratio matter?

A waxy, fat-like substance, cholesterol is found in all cells, and has an important part to play in various vital processes in the body. However, high blood or serum cholesterol is one of the risk factors in the development of heart disease. High cholesterol can increase the risk of a heart attack or stroke as fatty deposits can build up in the wall of arteries making them narrower. It’s a good idea to find out your cholesterol level.

There are two main types of cholesterol:

  • HDL (‘good’) cholesterol – HDL cholesterol carries cholesterol back to the liver, where it is broken down or eliminated. While lowering LDL-cholesterol is key, it’s a good idea to maintain ‘good’ HDL-cholesterol at or above the healthy level.
  • LDL (‘bad’) cholesterol – too much can cause fatty build-ups in the arteries. To maintain a healthy heart, try to keep LDL cholesterol at a lower, healthy level.

Your doctor may talk about non-HDL cholesterol. This is because LDL was previously used as the main measure of bad cholesterol, and is still a good indicator, but we now know that other forms of non-HDL cholesterol, as well as LDL are also harmful, and this test may be a more accurate way of estimating risk.

Your cholesterol ratio reveals, in fact, your HDL to cholesterol ratio – or in other words: the amount of ‘good’ HDL cholesterol in your total cholesterol. That’s why discovering yours may help you find out whether you may need to make changes in your diet and lifestyle.

However, high cholesterol is only one out of multiple risk factors for heart disease, so you should aim to reduce your cholesterol alongside other diet and lifestyle changes to lower overall risk of heart disease. Your doctor can calculate your overall risk of a heart attack or stroke in the next 10 years by using your cholesterol measurements with other factors, such as age, weight and blood pressure.

How do you calculate cholesterol ratio?

Your doctor or practice nurse will usually test your cholesterol levels. They will take a blood sample either using a needle and a syringe, or by pricking your finger. If a finger prick test is used the results can usually be checked there and then.

Your healthcare professional may calculate your cholesterol ratio by dividing your total cholesterol by HDL cholesterol level.

What should my cholesterol ratio be?

According to NHS Health Check, a ratio score of 4 or more may indicate heart or circulation problems.

Other cholesterol measurements of interest:

As a general guide, the NHS recommends that total cholesterol levels should be:

  • 5mmol/L or less for healthy adults
  • 4mmol/L or less for those at high risk

Of this LDL, or bad cholesterol, should be:

  • 3mmol/L or less for healthy adults
  • 2mmol/L or less for those at high risk

A healthy level of HDL should be above 1mmol/L.

When to get your cholesterol tested

Cholesterol levels aren’t fixed – they vary daily – and can depend on a number of factors, like diet and lifestyle choices. Your GP may recommend that you have your blood cholesterol levels tested if you are higher risk for example if you have high blood pressure, are overweight or obese or have a family history of early heart disease. If you have any concerns make sure to talk to your GP, nurse or pharmacist and they will work with you to work out your next steps.

Here you can find a comprehensive infographic with everything you need to know about cholesterol testing, from information on fasting and how to book a test to understanding your results.

Want more advice, including recipes and cholesterol lowering diet plans? Download our Cholesterol Lowering Starter Kit here! You can find out more about how to lower cholesterol, and how our product range can help with that, on this site.

BNF references:

  1. NHS Digital (2018). High cholesterol. (accessed 20/05/2019)
  2. British Nutrition Foundation (2019). CARDIOVASCULAR DISEASE: Diet, Nutrition and Emerging Risk Factors, 2nd Edition. Wiley Blackwell.
  3. National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summaries: Lipid modification – CVD prevention. (accessed 21/05/2019)
  4. British Heart Foundation (2018). Understanding cholesterol (booklet). (accessed 21/05/2019)
  5. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart Journal (2016) 37: 2999–3058. (accessed 21/05/2019

The British Nutrition Foundation has reviewed the accuracy of the scientific content of this page in May 2019 (please note this does not include linked pages). The Foundation does not endorse any brands or products.  For more information about the Foundation, please visit www.nutrition.org.uk

This information has been included in good faith, but is for general informational purposes only, and should not be construed as a guarantee. The nutritional facts and statements on this site are designed for educational and resource purpose sonly, not being substitutes for professional advice. If you have any concerns or questions about your health, you should always check with your GP or healthcare professional.