Your Ratio of HDL to LDL Is More Important Than You Think

HDL and LDL—not just your total cholesterol—can determine your risk for heart attacks

By Roberta H. Anding, MS, Baylor College of Medicine and Texas Children’s Hospital
Edited by Kate Findley and proofread by Angela Shoemaker, Wondrium Daily

When evaluating your risk for heart disease, a doctor will typically test your total cholesterol. However, this number does not tell the whole story. Professor Anding explains why knowing your HDL (good cholesterol) and LDL (bad cholesterol) is also crucial.

Healthy salad with doctor stethoscope
Your total cholesterol number is not the only figure you should be paying attention to when evaluating your risk for heart disease, both the HDL and the LDL levels are risk indicators. Photo By ARTFULLY PHOTOGRAPHER / Shutterstock

What Makes LDL Bad?

Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol work in direct contrast to one another. LDL, colloquially known as “bad cholesterol,” carries fat for deposition into cells, including the smooth muscle cells of your arterial walls.

Increased LDL levels are associated with a higher risk of heart disease. Currently, the recommended amount is less than 100 milligrams per deciliter, but some agencies are now challenging this figure and recommending that your LDL be as low as possible.

In fact, if you have pre-existing diabetes, many agencies will recommend less than 70 milligrams per deciliter. You might not be able to accomplish this figure through diet alone, thus requiring some medication support.

HDL and Heart Disease Risk

HDL, by contrast, is known as the “good cholesterol.” This is your “garbage collector,” removing surplus cholesterol and fat from tissues, including the arterial wall. 

The higher your HDL, the lower your heart disease risk. Again, depending on the source, some suggest that having an HDL that is greater than 60 milligrams per deciliter is a negative risk factor. 

“I can tell you I’m very excited,” Professor Anding said. “Although my cholesterol is high, my HDL sits in that range of 90 to 95. So I have less heart disease risk because I have that high HDL.”

If that value is less than 40 milligrams per deciliter for men, or less than 50 in women, you might have an issue. 

“I’ve seen multiple people who have a total cholesterol value of 200, which sounds good, but their HDL is 20,” Professor Anding said. “That’s not good.”

Thus, your total cholesterol—which is the sum total of your cholesterol and can be viewed as an umbrella under which all the specific forms of cholesterol are classified—is important to know, but it is not the only figure you should be paying attention to when evaluating your risk for heart disease. 

Going Beyond Total Cholesterol

You should also be paying attention to these subcategories of cholesterol including LDL and HDL. For the man who has a total cholesterol value of 200 and an HDL of 20, resulting in a  ratio of 10.

Estimates of heart disease risk typically combine data for both men and women, and a ratio of greater than 4.5 indicates a greater risk of heart disease. This individual, then, has a high risk for heart disease even though his total cholesterol falls within the range recommended by public health officials which is 200 milligrams per deciliter or lower. 

“A very good friend of mine is a cardiovascular nurse educator for a big metropolitan hospital in Houston,” Professor Anding said. “She reports that the average person having a heart attack at her hospital has a total cholesterol value of 210.”

Although a total cholesterol of 210 is only considered borderline high according to national recommendations, an individual’s HDL might be much lower than the minimum recommended values, putting them at serious risk for heart disease. 

“The key point here is you don’t just get your total cholesterol done because you can be lulled into a false sense of security,” Professor Anding said. “Get the lipid profile. The lipid profile is going to give you all the spokes to that umbrella.”

This article was edited by Kate Findley, Writer for Wondrium Daily, and proofread by Angela Shoemaker, Proofreader and Copy Editor for Wondrium Daily.

Professor Roberta H. Anding is a registered dietitian and Director of Sports Nutrition and a clinical dietitian at Baylor College of Medicine and Texas Children’s Hospital. She also teaches and lectures in the Baylor College of Medicine’s Department of Pediatrics, Section of Adolescent Medicine and Sports Medicine, and in the Department of Kinesiology at Rice University.