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  • Q&A with Australian Health Practitioners

    How does total cholesterol differ from the ratio?

    Related Topics
    Cardiology & Vascular Health High Cholesterol
    Can someone please explain to me how to interpret cholesterol levels? What does it mean when someone refers to the total cholesterol level versus the ratio?
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    Arlene Normand

    Dietitian

    Arlene is a registered practising dietitian, with a private practice in the Eastern Suburbs of Sydney, and has built a strong business over the last … View Profile

    I'm glad you asked this question since deciphering your results can be confusing. The total cholesterol to HDL cholesterol ratio is a number that is helpful in predicting atherosclerosis, the process of fatty build up in the walls of the arteries. The number is obtained by dividing total cholesterol by HDL (good) cholesterol. For example, if a person has a total cholesterol of 5.1 mmol/l  and an HDL cholesterol level of 1.2 mmol/l, the ratio would be 4.0. A high ratio indicates a higher risk of heart attack while a low ratio indicates a lower risk. High total cholesterol (an indicator that your body has a lot of the lipoproteins that contribute to atherosclerosis) and low HDL cholesterol increases the ratio, so that scenario is undesirable. Conversely, low total cholesterol and high HDL cholesterol lowers the ratio and is good news.
    The goal is to keep the ratio below 5.0; the optimum ratio is 3.5. But even though this ratio can be a powerful predictor of heart disease risk, it is not used as a sole indicator for therapy. So while this ratio will help you understand your risk, keep in mind that your physician will be making treatment choices based upon your other lipoprotein numbers, specifically your LDL and HDL levels.

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    April_Murwillumbah

    HealthShare Member

    An excellent & clear explanation. Thank you.

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    Dr Subhash Verma

    GP (General Practitioner)

    Dr. Verma has wide experience in the field of medicine. After completing his MBBS he has obtained Post Graduate Degree and Diploma in Paediatrics, Obstetrics … View Profile

    Total cholesterol is a measure of the good and the bad cholesterol, excluding triglycerides. The difference of the cholesterol depends on the concentration of the protective nature of cholesterol in your body, and the destructive nature, which is the HDL and LDL. So the total cholesterol does not give you an indication of your ill health or the risk factors, while the differentiation of the cholesterol will tell you what your risk factors are, and how to manage them.

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    Dr Jason Kaplan

    Cardiologist (Heart Specialist)

    Dr. Jason Kaplan is a specialist adult cardiologist and physician. Dr. Kaplan studied Medicine at UNSW and graduated with Honours in 1999 then completed his … View Profile

    Total cholesterol is a number made up of a combination of high density lipoprotein, plus low density lipoprotein and other what’s called non HDL lipoproteins. These include lipid molecules such as very low density lipoprotein and intermediate density lipoprotein. These VLDL and IDL molecules carry triglycerides and harmful fat molecules.

    The ratio that is often seen in cholesterol profiles, consists of the ratio of total cholesterol to HDL cholesterol. HDL cholesterol is good cholesterol, and good cholesterol is protective against heart disease, and thus the ratio that’s often quoted is the ratio of total cholesterol to HDL cholesterol. It is a ratio that is more useful in females. In males, the ratio of greater than 6.4 confers approximately 5%-10% greater risk predicted from using LDL cholesterol alone. In females the ratio of greater 5.6 confers a risk of somewhere between 30%-40% greater than just using LDL cholesterol alone. In traditional risk models, looking at people’s heart disease, LDL cholesterol, which is commonly known as bad cholesterol, has been the main way we calculate cardiovascular risk.

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