Key takeaways
- Your cholesterol ratio is your total cholesterol divided by your HDL ("good") cholesterol, worked out from one lipid profile sample.
- A lower ratio is generally better, because more of your cholesterol is the protective HDL type.
- Two people with the same total cholesterol can have very different ratios, which is exactly why the ratio is useful.
- Your doctor feeds the ratio into an overall heart risk score, such as QRISK3, with your other risk factors.
Your report shows a total cholesterol, an HDL and then a third figure, the ratio. The first two make some sense, but the ratio is the one your doctor keeps mentioning.
Your cholesterol ratio is your total cholesterol divided by your HDL cholesterol. A lower number is generally better, because it shows more of your cholesterol is the protective HDL type. NHS guidance generally describes a ratio above 6 as high. Both figures come from one lipid profile blood test.
To find out your own, book a lipid profile at 117a Harley Street. It costs £72.50 plus the £50 blood draw, with results back in 1 day.
How is the cholesterol ratio calculated?
The ratio is simply total cholesterol divided by HDL cholesterol, both measured from the same sample. A total cholesterol of 5 mmol/L and an HDL of 1.25 mmol/L, for example, gives a ratio of 4.
The ratio relates two results to each other, so it needs no separate measurement. Your report shows both figures. If the ratio itself is missing, you or your doctor can work it out by dividing one by the other. If you only need the HDL cholesterol figure, it can be tested by itself for £58.13, with results in 1 day.
Why does the ratio matter alongside the individual numbers?
Two people can have the same total cholesterol but very different risk, depending on how much of that total is protective HDL. Someone with a high total but also a high HDL can have a lower ratio than someone with a lower total and very low HDL. That gives them a different risk picture, so doctors look at the ratio as well as the individual LDL, HDL and total figures.
| Reading | What it generally suggests |
|---|---|
| Lower ratio | A greater share of protective HDL cholesterol relative to the total |
| Higher ratio | A smaller share of HDL relative to the total, generally regarded as less favourable |
| Above 6 | Described by NHS guidance as a high ratio |
This is the general pattern. Your doctor interprets your ratio alongside your full cardiovascular risk picture.
Is a lower ratio always better?
Broadly, yes. A lower ratio is generally more favourable, and your doctor reads it with everything else. That means your LDL and non-HDL cholesterol, plus your blood pressure, smoking, weight, family history and other risk factors. These usually come together in a risk score such as QRISK3.
The ratio adds context to the individual figures. Our guide to normal cholesterol levels explains each one.
Can I improve my cholesterol ratio?
The ratio reflects both your total cholesterol and your HDL. Anything that lowers the total or raises HDL can improve it. Diet, regular activity, stopping smoking and reaching a healthy weight are the usual starting points, and some people also need medication. Whether lifestyle change is enough, or treatment is also needed, is a decision for your doctor based on your full risk picture.
Are there tests that look at heart risk in more detail than a standard ratio?
Yes, for people who want more depth than the ratio gives.
- The advanced heart health blood test adds apolipoproteins A1 and B, lipoprotein(a), high-sensitivity CRP and Lp-PLA2 to a full lipid profile. It costs £495, with results in up to 3 working days, and a 10 to 12 hour fast is preferred.
- Cardiovascular Risk Profile 1 covers a similar set of markers for £471.25, with results in 3 days.
Both prices are for the test itself, plus the £50 blood draw. If you would like a specialist opinion on your heart risk, the cardiology clinic at Medical Express Clinic can go through your results with you.
Chest pain, especially with breathlessness, sweating or pain spreading to the arm or jaw, is an emergency: call 999.
How cholesterol testing works at our Harley Street clinic
Most people can eat normally before a lipid profile. You can walk in or book online at 117a Harley Street, seven days a week, with no GP referral needed. Results are sent by email, usually within 1 day.
You can book the lipid profile on its own or with any of our other private blood tests in London in the same visit. You can also add a doctor review of your report for £75. When you are ready, start your booking.
Frequently asked questions
What is a normal cholesterol ratio?
There is no single number that suits everyone, but NHS guidance generally describes a ratio above 6 as high. Your doctor reads your ratio alongside your overall risk factors.
Is the cholesterol ratio more important than total cholesterol?
Neither figure is used alone. The ratio adds context to your total cholesterol by showing how much of it is the protective HDL type. Your doctor looks at both together with your wider risk picture.
Does the cholesterol ratio use non-HDL cholesterol instead of total?
The ratio most commonly quoted is total cholesterol divided by HDL. Non-HDL cholesterol is a separate figure that some doctors also use, and it is reported directly on your lipid profile.
Can my ratio be high even with normal total cholesterol?
Yes. When your HDL is low, your ratio can be higher than expected even when your total cholesterol looks fine. That is one reason the ratio is calculated in the first place.
Do I need a separate test to get my cholesterol ratio?
No. A standard lipid profile measures both total and HDL cholesterol, so the ratio comes from the same sample.
How often should I recheck my ratio?
That depends on your risk factors and any treatment, and is best agreed with your doctor. The NHS Health Check, which includes a cholesterol test, is offered every 5 years to adults aged 40 to 74. People on treatment are usually tested more often.
References
- Cardiovascular disease: risk assessment and reduction, including lipid modification (NICE)
- High cholesterol (NHS)
- High cholesterol: cholesterol levels (NHS)
- QRISK3 risk calculator (ClinRisk)