Cholesterol-HDL Ratio Blood Test

Total Cholesterol to HDL Ratio (TC:HDL): What It Is, How to Use It, and How to Improve It

The Total Cholesterol to HDL ratio (TC:HDL) compares the amount of all cholesterol in your blood to the portion carried by high-density lipoprotein (HDL), the “good” cholesterol. Because HDL helps remove cholesterol from the bloodstream, a lower TC:HDL ratio generally reflects a more favorable balance and a lower cardiovascular risk.

How the Ratio Is Calculated

Formula: TC:HDL ratio = Total Cholesterol (mg/dL) ÷ HDL (mg/dL)
Example: If your total cholesterol is 200 mg/dL and your HDL is 50 mg/dL, your ratio is 4.0.

Quick Reference: TC:HDL Ratio Ranges

Note: Ranges are general guides. Always interpret your ratio alongside LDL, triglycerides, blood pressure, glucose/A1C, inflammatory markers, age, smoking status, and family history.

Why the Ratio Matters

• Context beyond single numbers: The ratio captures the balance between cholesterol carried in circulation and the HDL that helps clear it.
• Actionable: You can improve the ratio by lowering total cholesterol (especially LDL) and/or raising HDL.
• Monitoring tool: Useful for tracking progress after lifestyle changes or treatment.

How to Improve Your TC:HDL Ratio

• Move more: Aim for at least 150 minutes/week of moderate aerobic activity; add resistance training 2–3 days/week.
• Eat for heart health: Emphasize vegetables, fruits, legumes, whole grains, nuts, seeds, and oily fish (omega-3s). Limit saturated fats, trans fats, and refined carbs.
• Manage weight & waist circumference: Even modest weight loss can raise HDL and lower total cholesterol.
• Don’t smoke; moderate alcohol: Smoking lowers HDL; if you drink, do so in moderation (or avoid).
• Work with your clinician: Some people benefit from lipid-lowering medications or targeted supplements (per medical guidance).

When to Test

The TC:HDL ratio is reported with a standard lipid panel. Many adults begin screening in early adulthood (often every 4–6 years if low risk) and test more frequently with additional risk factors, existing cardiovascular disease, diabetes, or when starting or adjusting therapy.

Limitations & Helpful Add-Ons

• It’s a ratio, not the whole story: It does not reveal LDL particle number/size, LDL oxidation, or inflammation.
• Consider complementary markers: ApoB, non-HDL-C, hs-CRP, triglycerides, lipoprotein(a), fasting glucose/A1C, and blood pressure.
• Consistency matters: For comparable results, test under similar conditions (fasting status, timing, medication adherence).

FAQs

Is a lower TC:HDL ratio always better?
Generally yes for cardiovascular risk, but extremely low cholesterol values should be interpreted in clinical context with your provider.

Can I improve my ratio without medication?
Many people do through diet, exercise, weight management, and smoking cessation. Some will still need medication based on overall risk.

Does fasting affect the ratio?
Fasting can improve the consistency of total cholesterol and HDL measurements. Follow your lab/provider instructions.