Cholesterol Ratio – What is a Normal Reading?

You’ve heard of good, bad, high, and low cholesterol. But what is cholesterol ratio, and what does it mean for heart health?

Add “cholesterol ratio” to the complex terminology of lipid panels. A lipid panel is a blood test that measures the amount of cholesterol and others fats in your blood. Warning: The terms are not for the faint of heart.

There’s cholesterol, total cholesterol, lipoprotein, high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL), Very-low-density lipoprotein (VLDL). Triglycerides. And now, cholesterol ratio.

Cholesterol Simplified

With the help of CDC’s Medline Plus, let’s start with cholesterol. It’s a waxy substance made by the liver and present in blood. We need it, but only in the right amounts. Too much or the wrong kind increases the risk of heart disease. (

Total Cholesterol

Total cholesterol is the amount of cholesterol in your blood, including low-density lipoprotein (LDL)—the bad kind of cholesterol—and high-density lipoprotein (HDL), the (so-called) good kind. The recommended total cholesterol value is 200 mg/dL or less. Borderline high is 200-239. Everything greater is high.

Low Density Lipoprotein

Low-density lipoprotein moves cholesterol through the arteries to various tissues in the body. It can accumulate on arterial walls. High levels increase the risk of heart disease and stroke. The CDC’s recommended LDL is “about” 100 mg/dL. “About” is a CDC term.

HDL Cholesterol

HDL absorbs cholesterol and moves it back to the liver before it is flushed out of the body. Normal HDL should be at least 40 mg/dL in men; 50 in women. Higher is better, but those numbers have been questioned.

A November 2022 study (20,000 subjects) in the Journal of the American College of Cardiology suggested that low HDL cholesterol was associated with increased cardiovascular risk in white but not Black adults. The high HDL did not appear to be protective in either group. (

In spite of the findings, major medical institution websites generally recommend higher HDL levels for heart health. Mayo Clinic—60 for women and men; Cleveland Clinic—60+ for men and women; Harvard—60 for women, 45 for men; Johns Hopkins—55+ for women, 45+ for men.

Non-HDL Cholesterol

A non-HDL level is determined by subtracting HDL from total cholesterol. It includes other types of cholesterol (like VLDL). Good (normal) is less than 130 mg/dL for people without risk factors such as high blood pressure, diabetes, obesity, and vascular disease.


Triglycerides are the most common type of fat found in blood. Think oils, butter, carbs, alcohol. The National Institutes of Health report that between 25 and 30 percent of Americans have abnormally high levels. Below 150 mg/dL is recommended.

Why is Cholesterol Ratio Important?

Instead of relying solely on the numbers just described to determine risk, there has been a shift toward taking cholesterol ratio into consideration. It’s a measurement of both good (HDL) and bad (LDL) cholesterol. To calculate it, divide your total cholesterol by your HDL. Here’s an example of a cholesterol ratio reading:

(Total cholesterol) 150 ÷ (HDL) 60 = cholesterol ratio of 2.5

According to the American Heart Association, the target number is 3.5; lower is better. Anything higher than 3.5 increases the risk of cardiovascular disease.

Treat the Patient, Not the Numbers

Each patient is different, and treatment for cholesterol-related issues should be individualized. Men may have different recommended values than women. One person could have a total cholesterol reading within a normal range but HDL and LDL values out of range. Having other medical issues increases the risk in spite of good cholesterol numbers. Even a patient with normal numbers but a family history of heart disease may be at higher risk and in need of medical intervention.

How to Improve Cholesterol Ratio

The list of ways to lower your cholesterol ratio applies to many other health issues. Below are six suggestions.

  • Maintain a healthy weight.
  • Choose foods lower in saturated fats.
  • Avoid foods with trans fats.
  • Exercise regularly.
  • Don’t smoke.
  • Limit alcohol intake.

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Jim Brown, PhD

As a former college professor of health education, Jim Brown brings a unique perspective to health and medical writing. He has authored 14 books on health, medicine, fitness, and sports. … Read More

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