From the Guidelines
The Total Cholesterol (TC) to High-Density Lipoprotein (HDL) ratio is a crucial cardiovascular risk marker, with a desirable ratio being below 4:1, and optimal levels being closer to 3.5:1 or lower, as indicated by recent studies 1. This ratio is calculated by dividing your total cholesterol number by your HDL cholesterol level.
- A higher ratio indicates increased cardiovascular risk, while a lower ratio suggests better heart health.
- The TC/HDL ratio is considered more predictive of cardiovascular disease risk than total cholesterol alone because it accounts for the balance between "good" cholesterol (HDL) and total cholesterol levels.
- HDL helps remove other forms of cholesterol from your bloodstream, so having higher HDL levels relative to your total cholesterol is beneficial. Some key points to consider when evaluating the TC/HDL ratio include:
- The relationship between serum lipid levels and CVD risk is non-linear and potentially paradoxical in certain conditions, such as rheumatoid arthritis (RA) 1.
- Controlling disease activity has widespread effects on the lipid profile, and treatment with certain medications can result in an overall increase of lipid components, but mostly HDLc, which improves the TC/HDLc ratio 1.
- The TC/HDLc ratio is a better CVD risk predictor in RA than individual lipid components, and assessment of the lipid profile should preferably be done when a patient has stable disease or is in remission 1. Your healthcare provider might use this ratio alongside other lipid measurements and risk factors when assessing your overall cardiovascular health and determining if lifestyle changes or medication might be needed, as supported by studies such as 1 and 1. Regular lipid panel testing can help monitor this ratio over time.
From the Research
Total Cholesterol to High-Density Lipoprotein (HDL) Ratio
The Total Cholesterol (TC) to High-Density Lipoprotein (HDL) ratio is a measure used to assess the risk of atherosclerotic cardiovascular disease. This ratio is calculated by dividing the total cholesterol level by the HDL cholesterol level.
Calculation and Interpretation
- The TC/HDL ratio is a useful indicator of cardiovascular risk, as it takes into account both the total cholesterol level and the HDL cholesterol level 2, 3.
- A higher TC/HDL ratio is associated with a greater risk of cardiovascular disease, as it indicates a higher level of total cholesterol and a lower level of HDL cholesterol 4, 5.
- The TC/HDL ratio can be used to identify individuals who are at high risk of cardiovascular disease, even if their LDL cholesterol level is within the normal range 2, 6.
Association with Cardiovascular Risk
- Studies have shown that the TC/HDL ratio is a strong predictor of cardiovascular risk, independent of other lipid parameters such as LDL cholesterol and triglycerides 3, 4.
- The TC/HDL ratio has been shown to be associated with an increased risk of cardiovascular events, such as heart attacks and strokes, in both men and women 2, 5.
- The ratio has also been linked to an increased risk of peripheral arterial disease, as indicated by a low ankle-brachial index (ABI) 6.
Clinical Significance
- The TC/HDL ratio can be used as a tool for risk assessment and management of cardiovascular disease 2, 4.
- A high TC/HDL ratio may indicate the need for lifestyle modifications, such as diet and exercise, or pharmacological interventions, such as statin therapy 4, 5.
- The ratio can also be used to monitor the effectiveness of treatment and adjust therapy as needed 3, 6.