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Continuing with Griff’s excellent post


There are three ratios that scientists have found which measure the impact of cholesterol in the body. These are the ratios between the total amount of cholesterol measured and the HDL (Total/HDL), between triglycerides and HDL (Trig/HDL), and between LDL and HDL (LDL/HDL). Each one is an indicator of something different. Many doctors don’t pay attention to these ratios, and that’s a shame, because they’re a far better indicator of cardiovascular health than the total cholesterol number. You’ll see why in a minute.

The ideal ratio of Total/HDL is 4.4 for women and 5 for men. Also, according to http://www.yourmedicaldetective.com/public/523.cfm and several other sites, the ratio of your trigs to your HDL will indicate whether your LDL is small and dense (bad – Pattern B) or large and fluffy (neutral – Pattern A). A larger number indicates smaller LDL particles and a smaller number indicates larger LDL particles. It’s an inverse relationship.

The ideal ratio of Trig/HDL is 2 or below. 4 is high. 6 is “danger!!” This ratio indicates the level of risk for heart disease. Additionally, a low ratio of Trig/HDL is great because it’s a semi-reliable indicator of lower free insulin levels. Lower free insulin is good. (However, this doesn’t appear to work for those of African descent, so take that with a grain of salt.)

The ideal ratio of LDL to HDL is 4.3 or lower. 4.4 to 7.1 is average. 7.1 to 11 is moderate. 11 or more means you’re at high risk for developing heart disease. The ratio of LDL to HDL is considered to be a marker of carotid plaque, or how much plaque you have built up in your arteries.


So if we look at Joe’s results (using the Iranian equation), his ratios are:

Total/HDL: 250/70 or 3.57 (ideal = 5 or below)

Trig/HDL: 40/70 or 0.57 (ideal = 2 or below)

LDL/HDL: 129/70 or 1.84 (ideal = 4.3 or below)

Even if we use the Friedewald equation (with its misleading, overestimated LDL), Joe still does pretty well:

Total/HDL: 250/70 or 3.57 (ideal = 5 or below)

Trig/HDL: 40/70 or 0.57 (ideal = 2 or below)

LDL/HDL: 172/70 or 2.45 (ideal = 4.3 or below)

In all cases, Joe’s ratios are well below the “ideal” – and being below the ideal is awesome. And look at that ratio of trigs to HDL! It’s a great indicator of lower free insulin levels for Joe, and the ratio of Total/HDL also says that his LDL is probably (mostly) Pattern A.

Let’s compare that to Pat, who’s been on a low-fat, high-carb diet and exercising with chronic cardio, and whose doctor thinks he’s doing really well because his cholesterol tests came back with these numbers:

Total: 180

HDL: 25

LDL (calculated with the basic Friedewald equation): 131, or (calculated with the Iranian equation): 153

Triglycerides: 120
Pat’s ratios are:

Total/HDL: 180/25 or 7.2 (ideal = 5 or below)

Trig/HDL: 120/25 or 4.8 (ideal = 2 or below)

LDL/HDL: 131/25 or 5.24 (Friedewald LDL); 153/25 or 6.12 (Iranian LDL) (ideal = 4.3 or below)

Compared to Joe, Pat’s got one foot in a heart disease grave! His Total/HDL is way above the ideal, his trig/HDL is in the “nearly danger” zone, and his LDL/HDL says “Look, you’re at average risk for heart disease and heading higher.” But if the doctor only focuses on total cholesterol, Joe’s the one who’ll be put on a statin, while Pat might be advised to find ways to bring up that HDL number a little bit, if his doctor does anything other than congratulate him on his “good” cholesterol numbers. And way too many doctors focus only on total cholesterol.