Home Biomarkers LDL : HDL ratio

LDL : HDL ratio

Lipids Biomarker

Sample Needed

Collection Type: Blood

Body System

Related System: Lipids

Overview

The LDL:HDL ratio compares the concentration of low‑density lipoprotein cholesterol (LDL, the atherogenic “bad” cholesterol) to high‑density lipoprotein cholesterol (HDL, the protective “good” cholesterol). It is calculated from a fasting or non‑fasting lipid panel and expresses overall atherogenic risk: higher ratios mean more LDL relative to HDL and greater risk of plaque formation and cardiovascular disease (CVD). The ratio is used to suspect or monitor coronary artery disease, atherosclerosis, and stroke risk. Symptoms prompting testing include chest pain, exertional shortness of breath, unexplained fatigue, or any signs of ischemia. Values vary with age, sex (men tend to have higher ratios than premenopausal women), menopausal status, pregnancy, and ethnicity; ratios tend to rise with age and with metabolic conditions like diabetes.

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Test Preparation

Overnight fasting (8-12 hrs) is required
Do not eat or drink anything except water before the test

Why Do I Need This Test

Profile: included in the Lipids (lipid) profile.
Symptoms: chest pain, palpitations, syncope, claudication, or assessment after abnormal lipid results.
Conditions: assesses risk/monitoring of atherosclerotic cardiovascular disease, guides lipid‑lowering therapy.
Reasons for abnormal levels: high LDL, low HDL, poor diet, obesity, diabetes, hypothyroidism, certain medications, genetic dyslipidemias.
Biological meaning: elevated ratio = higher atherogenic burden; low ratio = relatively protective lipid balance.
Lifestyle/family: smoking, high saturated fat intake, physical inactivity, excess alcohol raise ratio; family history of premature CVD or familial hypercholesterolemia warrants testing.

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Understanding Test Results

<1.0: Excellent very low atherogenic risk (rare; usually reflects very high HDL and/or very low LDL).
Associated with low CVD risk.
1.0–2.5: Optimal/Low risk desirable balance of LDL to HDL; routine prevention and lifestyle measures recommended.
2.5–3.5: Moderate risk increased atherogenic risk; consider intensifying lifestyle changes (diet, exercise, smoking cessation) and evaluate for secondary causes (diabetes, hypothyroidism).
May prompt discussion of pharmacologic therapy depending on overall risk score.
3.5–5.0: High risk substantially increased risk of atherosclerotic cardiovascular events; investigate causes, optimize non‑pharmacologic measures, and usually initiate or intensify lipid‑lowering therapy per risk assessment.
>5.0: Very high risk indicates marked atherogenic dyslipidemia and often genetic or severe secondary causes; urgent cardiovascular risk management and specialist referral are typically required.
Note: Interpretation should be combined with absolute LDL, HDL, total cholesterol, triglycerides and global CVD risk (age, blood pressure, smoking, diabetes).
Values can change with fasting status, recent illness, medications, and laboratory methods.

Normal Range

Less than 2.5 (unitless ratio)

FAQs

Q: What is a good HDL LDL ratio?

A: There's no single universally accepted HDL/LDL ratio. Aim for low LDL (preferably <100 mg/dL) and higher HDL (≥60 mg/dL). That commonly yields an HDL/LDL ratio around 0.4–0.6, which is associated with lower cardiovascular risk. Also watch total cholesterol/HDL—values under about 4 are desirable. Talk to your clinician for individualized targets.

Q: What is a low LDL/HDL ratio?

A: A low LDL/HDL ratio means LDL (“bad”) cholesterol is low relative to HDL (“good”) cholesterol, which generally signals lower cardiovascular risk. Ratios roughly below 3.0 are considered favorable, with values under about 2.0–2.5 viewed as optimal. Individual targets vary by age, health and risk factors, so interpret this ratio alongside total lipids and clinical advice from your clinician.

Q: Is 2.5 a good LDL to HDL ratio?

A: An LDL/HDL ratio of 2.5 is generally considered favorable and suggests a lower cardiovascular risk. However, overall risk depends on absolute LDL and HDL levels, triglycerides, blood pressure, diabetes status and other factors. Review your full lipid panel and risk profile with your clinician; lifestyle changes or medication may be advised based on total risk.

Q: How to balance HDL/LDL ratio?

A: Raise HDL and lower LDL by eating more soluble fiber, fatty fish, nuts, seeds and olive oil, and replacing saturated/trans fats with unsaturated fats. Exercise regularly (≈150 minutes/week), lose excess weight, stop smoking and limit alcohol. Control blood sugar and blood pressure. If lifestyle changes aren’t enough, follow your clinician’s advice on cholesterol-lowering medication and regular lipid testing to monitor progress.

Q: What is a good triglyceride level?

A: A good fasting triglyceride level is below 150 mg/dL (under 1.7 mmol/L). Levels 150–199 mg/dL are borderline high, 200–499 mg/dL are high, and ≥500 mg/dL are very high (risk of pancreatitis). For heart health many clinicians prefer values under 100 mg/dL. Manage high triglycerides with diet, weight control, exercise and medications when recommended.

Q: What causes high LDL HDL ratio?

A: A high LDL/HDL ratio results from elevated LDL and/or low HDL. Common causes include unhealthy diet (high saturated and trans fats, refined carbs), physical inactivity, obesity, smoking, excessive alcohol, type 2 diabetes, metabolic syndrome, hypothyroidism, certain medications, and genetic conditions like familial hypercholesterolemia. Age and sex (postmenopausal women) also raise the ratio.