Cholesterol & Heart Health · Calculated value
What does a high LDL to HDL ratio mean?
The short answer
The LDL to HDL ratio is your LDL cholesterol divided by your HDL cholesterol. A higher ratio means more LDL, the cholesterol that builds up in arteries, relative to protective HDL, and it is linked with higher heart disease risk. The ratio has no units. US guidelines set targets for LDL itself rather than for this ratio, so always read it alongside your LDL result.
What LDL/HDL ratio measures
The LDL to HDL ratio is not a separate test. It is your LDL cholesterol divided by your HDL cholesterol, and it appears on the Wolfburgh report as a calculated value. An LDL of 120 mg/dL with an HDL of 50 mg/dL gives a ratio of 2.4.
MedlinePlus calls LDL the bad cholesterol because a high level leads to a build-up of cholesterol, as plaque, in the arteries. HDL carries cholesterol from other parts of the body back to the liver. The ratio rises when LDL goes up, when HDL goes down, or both. Because both are cholesterol measured in the same units, it has no units.
On many lab reports LDL itself is calculated using the Friedewald formula: total cholesterol minus HDL minus triglycerides divided by 5. So this ratio is built from three measured results and carries the limits of that calculation. The formula becomes less accurate as triglycerides rise above about 250 mg/dL, is not recommended above 400 mg/dL, and tends to under-read LDL when LDL is very low.
LDL/HDL ratio ranges
No US guideline publishes target bands for the LDL to HDL ratio. The rows below show what the ratio works out to when LDL and HDL sit at the levels MedlinePlus describes as optimal or healthy.
| Result | Range |
|---|---|
| Optimal LDL with a healthy HDL (men)What an LDL below 100 mg/dL and an HDL above 40 mg/dL work out to | Below 2.5 |
| Optimal LDL with a healthy HDL (women)What an LDL below 100 mg/dL and an HDL above 50 mg/dL work out to | Below 2.0 |
| Example of a less favourable patternAn LDL of 160 mg/dL (high, MedlinePlus) with an HDL of 40 mg/dL | 4.0 |
These rows are arithmetic from the LDL and HDL levels, not separate thresholds, and some labs print their own bands for this ratio. Reference ranges vary between laboratories, and the range printed on your own report takes priority. Ranges vary between laboratories, and the range printed on your own report takes priority.
What a high LDL to HDL ratio means
A high ratio means your LDL is high, your HDL is low, or both, and higher ratios are linked with higher cardiovascular risk. In the Women's Health Study of 15,632 initially healthy US women, those in the highest fifth of the ratio had 3.18 times the risk of a first cardiovascular event of those in the lowest fifth, against 1.62 times for LDL alone.
Current US guidance gives the ratio little formal weight. The 2018 ACC/AHA guideline sets treatment goals in terms of LDL itself, lists an LDL of 160 mg/dL or more as a risk-enhancing factor, and does not use this ratio. In the JUPITER trial of people taking a statin, LDL on treatment predicted remaining risk as well as the ratio did, and the ratio added nothing once LDL was known. A high ratio is a reason to look at both numbers, and your overall risk, with your doctor.
Common causes
- A diet high in saturated fat, which raises LDL
- Overweight, which tends to raise LDL and lower HDL
- Too little physical activity
- Smoking or second-hand smoke, which lower HDL
- Inherited high cholesterol, such as familial hypercholesterolaemia
- Some medicines, including some steroids, blood pressure medicines and HIV medicines
- Rising age, and menopause in women, which tend to push LDL up
What a low LDL to HDL ratio means
A low ratio is generally favourable: in the Women's Health Study, risk was lowest in the lowest fifth of the ratio. Check that the LDL behind it is reliable, though. A calculated LDL tends to under-read when LDL is very low, which would make the ratio look better than it is, and it becomes less accurate when triglycerides are high.
What moves LDL/HDL ratio
Nutrition
MedlinePlus advises limiting saturated and trans fats to lower LDL, and eating unsaturated fats in their place while limiting sugar to support HDL. The Nutritionist turns that into specific swaps in the meals you already eat.
Training
MedlinePlus advises 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days to raise HDL, and notes that inactivity can lead to weight gain, which raises LDL.
Sleep and stress
We have not found strong direct evidence that sleep or stress alone changes this ratio. Where they drive late eating, alcohol or missed training, those habits are the practical target.
Habits
Smoking lowers HDL, so stopping helps the ratio. If you are overweight, losing weight can lower LDL, and losing it from around the waist can raise HDL (MedlinePlus).
How fast LDL/HDL ratio can change
US guidance repeats a lipid test 4 to 12 weeks after starting or adjusting cholesterol medication, to check the response to medication and lifestyle change (2018 ACC/AHA guideline, summarised in American Family Physician). A Day 90 re-test falls just after that window, so it is a reasonable point to see the direction of travel. Look at LDL and HDL separately as well as the ratio, since a change in either moves it.
Before your test
- Follow the fasting instructions you were given. A calculated LDL is less reliable on a non-fasting sample, and that error passes straight into the ratio.
- If your triglycerides are above 400 mg/dL, the calculated LDL, and so this ratio, should not be relied on.
- Look at the numbers behind the ratio: an LDL of 100 mg/dL with an HDL of 40 mg/dL and an LDL of 150 mg/dL with an HDL of 60 mg/dL both give 2.5.
When to speak to your doctor
Speak to your doctor if your LDL or the ratio is above the range on your report, especially with high blood pressure, diabetes, smoking or a family history of early heart disease. An LDL of 190 mg/dL or above is in the very high band (MedlinePlus) and is worth discussing soon, whatever the ratio. Seek emergency care straight away for chest pain or other signs of a heart attack or stroke; a blood result is never a reason to wait.
On the Wolfburgh panel
LDL to HDL Ratio is one of the 17 markers on the Wolfburgh blood panel. The lab calculates it from the measured markers on the same report, so it costs nothing extra and needs no extra sample. Your sample is collected at home with RedDrop One, an FDA-cleared collection device, and a licensed physician reviews every panel before your care team sees it.
The Nutritionist works on fat quality and sugar, the Trainer on regular aerobic activity, and the Behaviour Specialist on the habits that keep both going, because these move the LDL and HDL behind the ratio. Your Partner Physician reads the ratio with LDL itself, total cholesterol, triglycerides and the total cholesterol to HDL ratio, since LDL remains the main treatment target. Members re-test at Day 90, backed by the 90-Day Results Guarantee.
Common questions about LDL/HDL ratio
What is a good LDL to HDL ratio?
No US guideline sets one. As a guide, an LDL below 100 mg/dL (optimal) with an HDL above 40 mg/dL in men or above 50 mg/dL in women gives a ratio below 2.5 or below 2.0 respectively. Lower is generally better, but your LDL on its own matters most for treatment decisions, and the range on your own report takes priority.
Is the LDL to HDL ratio more important than LDL?
Not for treatment decisions: US guidelines set targets for LDL itself. Research on prediction is mixed. In the Women's Health Study the ratio predicted first cardiovascular events better than LDL alone, but in the JUPITER trial of statin users LDL predicted remaining risk as well as the ratio did. Treat the ratio as a summary and LDL as the number doctors act on.
How can I lower my LDL to HDL ratio?
Lower LDL, raise HDL, or both. MedlinePlus advises limiting saturated and trans fats, choosing unsaturated fats, limiting sugar, getting 30 minutes of moderate to vigorous aerobic exercise on most days, losing weight if you are overweight and not smoking. If you take cholesterol medication, keep taking it as prescribed and speak to your doctor before changing anything.
Why can two people with the same ratio have different risk?
Because a ratio hides the numbers behind it. An LDL of 100 mg/dL with an HDL of 40 mg/dL gives the same 2.5 as an LDL of 150 mg/dL with an HDL of 60 mg/dL, yet US guidelines judge LDL on its own level. Blood pressure, smoking, diabetes, age and family history also shape risk.
Sources
- JAMA (Ridker et al., Women's Health Study, 2005, PubMed). Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women
- Journal of the American College of Cardiology (Mora et al., JUPITER trial, 2012, PMC). On-treatment non-HDL cholesterol, apolipoprotein B, triglycerides, and lipid ratios in relation to residual vascular risk after treatment with potent statin therapy: JUPITER
- American Family Physician (AAFP). Cholesterol Management: ACC/AHA Updates Guideline
- Current Opinion in Cardiology (Wolska and Remaley, NIH, 2020, PMC). Measuring LDL-cholesterol: what is the best way to do it?
- MedlinePlus (NIH). LDL: The "Bad" Cholesterol
- MedlinePlus (NIH). HDL: The "Good" Cholesterol
This page is general information, not medical advice, and it does not replace a consultation with your own doctor. Never start, stop or change a medicine or supplement because of something you read here.
All 17 markers on the Wolfburgh panel
Cholesterol & Heart Health
- Total Cholesterol
- HDL Cholesterol
- LDL Cholesterol
- Triglycerides
- VLDL CholesterolCalculated
- LDL to HDL RatioCalculated
- Triglyceride to HDL RatioCalculated
- Total Cholesterol to HDL RatioCalculated
Blood Sugar
Inflammation
Iron
Liver Function
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