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Heart and vessels · Blood
Triglyceride/HDL ratio
Calculated ratio between triglycerides and HDL cholesterol; a rough impression of the lipid pattern in overweight and insulin resistance.
At a glance
- Measured in blood
- In 1 test panel
- No special preparation
Explanation
Triglyceride/HDL ratio: what is measured?
The ratio is calculated by dividing the triglycerides by the HDL cholesterol, two values that are measured separately in the blood. A high ratio means a lot of triglycerides (fats that the body stores as energy) and little 'good' HDL cholesterol. This pattern is common with belly fat, little exercise and insulin resistance (the body responds less well to insulin). The number depends on the unit: a ratio in mmol/l cannot be compared with a ratio in mg/dl from studies abroad.
What can it detect?
- Lipid pattern with high triglycerides and low HDL, as in overweight, metabolic syndrome and type 2 diabetes
- A sign of insulin resistance, without the ratio being able to prove it
Result
What does the result mean?
Triglyceride/HDL ratio too high
A high ratio means a lot of triglycerides compared with HDL. This fits the lipid pattern that goes with overweight around the belly, little exercise, a lot of sugar and alcohol, and disturbed blood sugar; people with this pattern have on average a higher risk of type 2 diabetes and cardiovascular disease. The ratio does not say which of the two values is abnormal: eating or alcohol shortly before the blood draw raises the triglycerides and therefore the ratio. A high ratio causes no symptoms.
Triglyceride/HDL ratio too low
A low ratio means few triglycerides compared with HDL and usually fits a healthy weight, regular exercise and a good response to insulin. A low ratio says nothing about LDL cholesterol, which can carry a high risk while this ratio is favorable. A low value causes no symptoms.
After an abnormal result
With a high ratio, the GP looks at the individual triglyceride and HDL values and, if needed, at weight, waist circumference, blood pressure and blood sugar (glucose or HbA1c). With high triglycerides, a fasting repeat measurement often 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 triglycerides and HDL. The risk of cardiovascular disease is estimated with SCORE2 based on non-HDL cholesterol; according to the multidisciplinary guideline on cardiovascular risk management, extra markers add little to that. Threshold values for the ratio come from studies abroad, often in other units, and have not been established for Dutch practice. The GP looks at the individual values, weight, blood pressure and blood sugar.
What can affect the result?
- Triglycerides fluctuate strongly with eating and alcohol in the hours and the day before the blood draw; as a result, the ratio also varies from measurement to measurement.
- A ratio calculated in mmol/l gives a different number than the same ratio in mg/dl; threshold values from abroad cannot be applied directly.
- HDL falls temporarily during an infection or other illness, which makes the ratio rise.
- Diabetes, an underactive thyroid, kidney disease and medicines such as corticosteroids, beta blockers and estrogens affect triglycerides or HDL.
Who it is for
Who is the test useful for?
Useful for
The ratio is only calculated if triglycerides and HDL have already been measured, for example in a broad package around sport and health; on its own it gives no extra information beyond the individual values. If you want to know whether you have disturbed blood sugar or an increased risk of cardiovascular disease, glucose or HbA1c, the full lipid profile, blood pressure and waist circumference are more useful. For athletes with a healthy weight, the ratio adds little.
How common is it?
There are no Dutch figures on a high triglyceride/HDL ratio. The underlying pattern of high triglycerides and low HDL is common in overweight and type 2 diabetes. In 2024, more than 1.6 million people in the Netherlands were known to their GP with a lipid metabolism disorder.
VZinfo.nl (RIVM) based on Nivel primary care registrations, 2024
Drawbacks and risks
- An unfavorable ratio after a meal or alcohol the evening before can cause unnecessary worry about blood sugar or the heart and blood vessels.
Get tested
Triglyceride/HDL ratio: test panels
Triglyceride/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.
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 results- NHG-Standaard Cardiovasculair risicomanagement (M84)
- FMS Richtlijnendatabase, richtlijn CVRM: Nuchter bloedprikken bij CVRM
- FMS Richtlijnendatabase: CVRM, module Andere voorspellers van het risico op hart- en vaatziekten
- NVKC, allesovertesten.nl: Lipidenprofiel
- VZinfo (RIVM): Cholesterol, op basis van Nivel Zorgregistraties Eerste Lijn 2024
More explanations
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