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Heart and vessels · Blood
HDL-LDL risk index
Calculated ratio between LDL and HDL cholesterol as a rough measure of the cholesterol balance; adds little to the individual values.
At a glance
- Measured in blood
- In 1 test panel
- No special preparation
Explanation
HDL-LDL risk index: what is measured?
This index is not a separate measurement but a calculation from two measured values: LDL cholesterol (the 'bad' cholesterol that is deposited in the blood vessel wall) divided by HDL cholesterol (the 'good' cholesterol that carries cholesterol away). The more LDL there is relative to HDL, the higher the index and the less favorable the balance. Such a ratio (usually total cholesterol divided by HDL) used to be used in the Dutch risk table; the current Dutch GP guideline (NHG) uses non-HDL cholesterol (total minus HDL) instead.
What can it detect?
- An unfavorable ratio between LDL and HDL as a general indication of a higher risk of cardiovascular disease
- Change in the cholesterol balance over time, for example after a lifestyle change
Result
What does the result mean?
HDL-LDL risk index too high
A high index means a lot of LDL relative to HDL: for example a high LDL with a normal HDL, or a normal LDL with a low HDL. Both combinations go with a higher risk of hardening of the arteries, but the index hides which of the two is the cause and how high the values themselves are. An index of 3 with an LDL of 6 mmol/l is something different from the same index with an LDL of 3 mmol/l. The GP therefore looks at the individual values and the overall risk profile, not at the index. A high index does not cause symptoms.
HDL-LDL risk index too low
A low index means little LDL relative to HDL and usually fits a favorable profile: a low LDL, a high HDL or both. Here too, the index hides the individual values: a low LDL due to an acute illness or a high HDL with heavy alcohol use also gives a 'good' index. A low index does not make up for other risk factors such as smoking, high blood pressure or diabetes.
After an abnormal result
With an abnormal index, the GP looks at the underlying LDL and HDL values, the non-HDL cholesterol and the overall risk profile, and acts on those; the index itself does not lead to separate follow-up.
Reliability
How reliable is the test?
The index is a derived risk marker with limited added value: everything it says is already in the measured LDL and HDL values. The risk estimate with SCORE2 from the Dutch GP guideline (NHG) on cardiovascular risk management is based on non-HDL cholesterol together with age, sex, smoking and blood pressure, and treatment aims at LDL or non-HDL. There are no agreed cutoff values for this index; the limits on a result are laboratory conventions. One value is not a diagnosis.
What can affect the result?
- All factors that disturb LDL and HDL carry over into the index: acute illness, pregnancy, thyroid function, alcohol, medicines and not being fasting with high triglycerides (calculated LDL then becomes unreliable).
- A ratio can be normal while both values are abnormal, or abnormal while the individual values are within the limits; always assess the individual values.
- Laboratories and providers use different formulas (LDL divided by HDL, or total cholesterol divided by HDL) and different cutoff values; results cannot be compared with each other.
Who it is for
Who is the test useful for?
Useful for
The index is only calculated when LDL and HDL have been measured anyway, for example in a broad health panel; as a standalone test it adds little. Anyone who wants to know their risk of cardiovascular disease benefits more from the full lipid profile plus blood pressure, smoking status and age, with which the GP can fill in the SCORE2 table.
How common is it?
There are no separate figures for an abnormal index. In 2024, just over 1.6 million people in the Netherlands were known to their GP to have a lipid metabolism disorder (about 9 in 100 inhabitants) and just over 1.7 million to have cardiovascular disease.
VZinfo (RIVM) based on Nivel primary care registrations, 2024
Drawbacks and risks
- A 'normal' index can reassure while the LDL is too high for someone's risk profile, and an 'abnormal' index can cause worry while the individual values and the risk are low.
Get tested
HDL-LDL risk index: test panels
HDL-LDL risk index is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and resultsMore explanations
Other tests: Heart and vessels
- Apo B/A1 ratio
- Apolipoprotein A1
- Apolipoprotein A2
- Apolipoprotein B
- Cholesterol, total
- Cholesterol/HDL ratio
- DHA
- EPA
- HDL cholesterol
- Homocysteine
- LDL cholesterol
- Lipoprotein(a)