Total cholesterol / HDL cholesterol ratio
CardiovascularThis ratio evaluates overall cholesterol relative to protective HDL cholesterol.
Also known as: cholesterol ratio, TC/HDL, TC-HDL ratio, cardiac risk ratio
It is a commonly used measure of lipid-related cardiovascular risk.
Reference range
Female
| Level | Range |
|---|---|
| High | above 6 |
| Intermediate | 4.5 to 6 |
| Normal | 0 to 4.5 |
Male
| Level | Range |
|---|---|
| High | above 6 |
| Intermediate | 5 to 6 |
| Normal | 0 to 5 |
Source: Ahead Health benchmark
* Reference ranges may vary between labs and assays. Always interpret results with your healthcare provider.
Why this matters
Higher values indicate a greater likelihood of plaque development and heart disease. Maintaining a lower ratio with a healthy diet, exercise, and smoking avoidance supports long-term cardiovascular protection.
How this connects to other biomarkers
- High ratio with normal ApoB suggests large particle dyslipidemia, while high ratio with elevated ApoB indicates numerous atherogenic particles.
- The ratio with inflammatory markers helps determine if dyslipidemia is primarily metabolic or inflammatory.
How often should I test Total cholesterol / HDL cholesterol ratio?
Most adults benefit from checking the total cholesterol to HDL ratio yearly as part of a lipid panel. After a sustained change in diet, body composition, or medication, retest at 6 to 12 weeks.
At baseline / for screening: Once every 12 months from age 30, alongside the rest of your lipid panel. Earlier and more frequent if you have a family history of early cardiovascular disease, elevated Lp(a), or known cardiovascular risk factors.
When monitoring an intervention or change: Retest 6 to 12 weeks after a sustained lifestyle change, such as reducing saturated fat, adding soluble fibre, meaningful weight loss, or a new aerobic routine. The same window applies after starting or adjusting cholesterol-lowering medication (statin, ezetimibe, bempedoic acid, PCSK9 inhibitor).
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