Heart and vessels · Blood

Cholesterol/HDL ratio

Calculated ratio between total cholesterol and HDL cholesterol; it says no more than those two separate values together.

At a glance

Measured in blood
In 3 test panels
No special preparation

Explanation

Cholesterol/HDL ratio: what is measured?

The ratio is calculated by dividing total cholesterol by HDL cholesterol, two values that are measured separately. Total cholesterol contains both the 'bad' cholesterol in LDL and other particles and the 'good' HDL cholesterol. A higher ratio means that a larger share of the cholesterol is in the harmful particles. Non-HDL cholesterol (total cholesterol minus HDL) directly reflects the cholesterol in all harmful particles; since 2024, the Dutch risk table has used that instead of the ratio.

What can it detect?

Unfavorable balance between harmful cholesterol and HDL cholesterol, which fits a higher risk of cardiovascular disease
Sign of the pattern of low HDL and high blood fats with overweight and metabolic syndrome

Result

What does the result mean?

Cholesterol/HDL ratio too high

A high ratio means a lot of cholesterol relative to HDL cholesterol, for example due to a high LDL, a low HDL or both. This fits a higher risk of hardening of the arteries, a heart attack and a stroke. There is no agreed limit above which the ratio counts as too high. A high ratio is often linked to overweight, little exercise, smoking and disturbed blood sugar; an underactive thyroid, kidney disease and some medicines also play a role. A high ratio causes no symptoms.

Cholesterol/HDL ratio too low

A low ratio means little harmful cholesterol relative to HDL and usually fits a favorable lipid profile. However, the ratio hides the separate values: a low total cholesterol due to an acute illness or a high HDL due to heavy drinking also gives a 'good' ratio. A low ratio does not make up for smoking, high blood pressure or diabetes.

After an abnormal result

With a high ratio, the GP looks at the underlying values (total cholesterol, HDL, LDL, non-HDL and triglycerides) and estimates the ten-year risk with SCORE2; depending on that, lifestyle advice, a repeat measurement or treatment follows. The ratio itself does not lead to separate follow-up.

Reliability

How reliable is the test?

The ratio is a derived value and adds no information to the measured total cholesterol and HDL values. Non-HDL cholesterol directly reflects the cholesterol in all harmful particles and is the value used by the SCORE2 risk table. Two people with the same ratio can have very different cholesterol values and risks. That is why the GP looks at the separate values and the overall risk profile, not at the ratio alone.

What can affect the result?

All factors that affect total cholesterol or HDL carry through into the ratio: acute illness, pregnancy, alcohol, smoking, weight and medicines.
During and for a few weeks after an infection, surgery or heart attack, both total cholesterol and HDL are temporarily low, which makes the ratio hard to interpret.
There is no nationally agreed cut-off value for the ratio; cut-off values differ between laboratories.

Who it is for

Who is the test useful for?

Useful for

The ratio is only calculated when total cholesterol and HDL have already been measured, for example in a broad package on weight or heart health; as a test on its own, it says little. If you want your risk of cardiovascular disease estimated, you get more from the full lipid profile with non-HDL cholesterol, together with blood pressure, smoking status, age and sex. The SCORE2 risk table is intended for people aged 40 and over.

How common is it?

There are no separate Dutch figures on an unfavorable cholesterol/HDL ratio. In 2024, more than 1.6 million people in the Netherlands were known to their GP with a lipid metabolism disorder, including high cholesterol, and more than 1.7 million with a cardiovascular disease, men more often than women.

VZinfo (RIVM) based on Nivel primary care registrations, 2024

Drawbacks and risks

A 'good' ratio can wrongly reassure you if LDL is still high or other risk factors are present, and a 'bad' ratio can cause worry while the overall risk is low.

Get tested

Cholesterol/HDL ratio: test panels

Cholesterol/HDL ratio is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Blood draw
Weight Loss Test
Panel for metabolism and weight; glucose, lipids, and hormones.
€ 89,00
Blood draw
Heart Complete Test
Lipid profile, kidney function, glucose, HbA1c, and NT-proBNP cardiac marker. Comprehensive cardiovascular health check.
€ 105,00
Blood draw
Whoop (Advanced Labs)
Comprehensive blood analysis with biomarkers that integrates directly with your WHOOP wearable for optimal performance and recovery.
€ 385,00

How reliable is the test?

Cholesterol/HDL ratio