What Is a Normal Range for a Chol/HDL Ratio?

When you get your cholesterol checked, one of the numbers will be a cholesterol/HDL ratio. That number is your total cholesterol divided by your high-density lipoprotein (HDL), also known as "good cholesterol." Healthcare providers usually consider a normal ratio to be below 5:1. A very good ratio would be 3.5:1 or lower.

The normal amounts of HDL are between 35 and 65 milligrams per deciliter (mg/dL) in adult males, and 35 to 80 mg/dL in females. When your overall cholesterol is over 200 mg/dL, you may be at higher risk of heart disease. If your chol/HDL level is high, your healthcare provider may want to discuss lifestyle changes or medication to better control your cholesterol levels.

This article looks at how a cholesterol ratio is calculated and what it means for your health. It also discusses ways to improve cholesterol levels.

What Is a Cholesterol Ratio?

Your cholesterol ratio is a comparison of how much HDL you have in your body compared to your total cholesterol level. Total cholesterol is a measure of all cholesterol in your blood, including the main types:

• High-density lipoprotein, which collects cholesterol and brings it to the liver so it can be removed
• Low-density lipoprotein (LDL, or "bad" cholesterol), which increases your risk of heart disease and stroke when over 130 milligrams per deciliter (mg/dL)
  

While important, total cholesterol doesn't reveal as much about your cardiovascular risk as knowing why your level is what it is.

Your total cholesterol could be high because LDL is more prevalent than HDL, which is harmful. But it could also be high because you have a lot of beneficial HDL. Therefore, your cholesterol ratio provides more information about your risk than just your total cholesterol number.

How Your Chol/HDL Ratio Is Calculated

Before calculating your cholesterol ratio, your healthcare provider will need to order a lipid panel test. These blood tests help determine how much of each type of cholesterol you have in your bloodstream. They also reveal your level of triglycerides, a stored type of fat that can also increase heart disease risk.

The chol/HDL ratio is then determined by dividing your total cholesterol by your HDL level.

For example, if your total cholesterol is 180 and your HDL is 60, your cholesterol ratio is 3 to 1.

The higher the ratio, the higher the risk.

Non-HDL Cholesterol vs. Cholesterol Ratio

Non-HDL cholesterol is another way healthcare providers try to determine your risk of heart disease. It includes LDL cholesterol and other types of cholesterol such as very-low-density lipoprotein (VLDL), which plays a role in cholesterol build-up in the arteries.

To obtain this number, your HDL cholesterol is subtracted from your total cholesterol.

A normal level of non-HDL cholesterol for adults is less than 130 mg/dL. The higher the number, the higher your risk of heart disease.

Some healthcare providers prefer non-HDL cholesterol, however. This is because non-HDL has a more linear relationship with your risk of heart disease. For example, as your non-HDL number goes up, your risk for heart disease goes up proportionally. This makes the number easier to interpret.

What Is a Normal Chol/HDL Ratio?

Your cholesterol ratio can determine if you are at risk for heart disease and if so, how high your risk is.

• Below 3.5 to 1: This ratio is considered optimal, putting you at very low risk for heart disease. Healthcare providers prefer to see cholesterol levels in this range, but it is not necessarily unhealthy for your levels to be slightly higher than this.
• Between 3.5 and 5 to 1: This ratio is considered normal. A cholesterol ratio within the normal range means that your cholesterol levels put you at lower risk for heart disease.
• Above 5 to 1: This result is considered high, putting you at elevated risk.

A high ratio is usually due to high LDL and/or VLDL cholesterol, or low HDL cholesterol. A combination of factors play into this, such as eating a lot of saturated fat, not getting enough exercise, age, and more.

Why Is Your Chol/HDL Ratio Important?

Too much LDL cholesterol in your blood can cause a type of heart disease called atherosclerosis.

This is a condition in which the flow of blood to the heart muscle is slowed. It can even stop blood from getting to the heart altogether, increasing your risk of a heart attack or stroke.

A 2019 study that looked at heart attack risk in women found that even people with "normal" ratios had an elevated risk of heart disease:

• Women with a cholesterol ratio of between 3.5 and 4 to 1 were 14% more likely to have a heart attack.
• Those with a ratio between 4 and 5 to 1 were 46% more likely to have a heart attack.
• Those with a 5 to 1 and above ratio were 89% more likely to have a heart attack.
  

How to Improve Your Cholesterol

If your cholesterol ratio comes back too high, there are things you can do to help improve your numbers. This includes lifestyle changes and medication.

Lifestyle Changes

If you want to improve your cholesterol levels, one of the best things you can do is to make lifestyle changes, such as with your diet and exercise.

Below are lifestyle habits you can change to help get cholesterol levels within normal ranges:

• Eat a heart-healthy diet. A heart-healthy eating plan usually limits the amount of saturated and trans fats that you eat while including healthier unsaturated fats, along with plenty of fruits, vegetables, whole grains, and lean protein. Examples of heart-healthy eating patterns include the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the Therapeutic Lifestyle Changes (TLC) diet.
• Maintain a healthy weight. High cholesterol levels can affect anyone, regardless of weight. However, having excess body weight is a risk factor for abnormal cholesterol levels. If you are overweight, losing even a modest amount of weight can help improve your cholesterol levels.
• Participate in physical activity. It’s recommended for adults to engage in moderate-intensity physical activity at least 150 minutes per week (about 30 minutes on most, if not all, days of the week).
• Manage your stress levels. Studies have shown that chronic stress might lower your HDL cholesterol and raise your LDL cholesterol.
• Quit smoking if you smoke. Smoking can increase your LDL cholesterol and decrease your HDL cholesterol.

Medication

If lifestyle changes alone are not enough to lower your cholesterol, you may also need to take cholesterol medication. Statins are the most common class of medications used to lower cholesterol. However, several different types of cholesterol-lowering medicines are available. 

The various medications work to lower cholesterol in different ways and can have different side effects. Do not stop taking your cholesterol medication if you feel a medication is not right for you. Always consult with your healthcare professional about stopping, changing, and/or finding the right medication for you.

In addition, don’t stop working to improve your lifestyle habits just because you are on cholesterol medicine. Cholesterol-lowering medications work best as you continue to implement heart-healthy lifestyle changes.

What Can Affect Your Chol/HDL Ratio?

A number of factors can affect your cholesterol levels, tests and, therefore, the ratio values between your total cholesterol and HDL. These factors include:

• Pregnancy
• Medications that you take
• Your diet in the week before the blood sample was taken
• Any alcohol consumption in the past two days
• Exercise and physical activity
• A recent heart attack (within the past three months)
  

Keep in mind that your age, gender, and any underlying medical conditions also affect test results.

Summary

Cholesterol ratio may be one of the tests reported when your healthcare professional checks your risk for heart disease. It is calculated from total cholesterol and HDL cholesterol. A lower number indicates lower risk, with the optimal level being between 3.5 to 1.