The published evidence is quite clear in documenting that the actual total cholesterol level itself is not the most important risk factor of cardiovascular disease.
It is the ratio between the level of HDL-“good” cholesterol and total cholesterol that we need to be concerned about.
Therefore, in adults, the HDL-“good” cholesterol/total cholesterol ratio should be higher than 0.24 (just divide your HDL level by your cholesterol).
Or more precisely, the HDL/total cholesterol ratio:
- 0.24 or higher is considered ideal
- under 0.24 – low
- less than 0.10 – very dangerous.
Generally speaking, the higher the ratio, the better (the lower your risk of a heart attack).
However, HDL is closely related to triglycerides.
It appears common for people with high triglycerides to have low HDL’s, and these same people also tend to have high levels of clotting factors in their blood stream, which is unhealthy in protecting against heart disease.
Therefore, in adults, the triglyceride/HDL-“good” cholesterol ratio should be below 2 (just divide your triglycerides level by your HDL).
Or more precisely, the triglyceride/HDL ratio:
- 2 or less is considered ideal
- 4 – high
- 6 – much too high
- And, since HDL (high density lipoprotein) is protective against heart disease, the lower the ratio, the better.
In other words, the lower your triglycerides, or the higher your HDL, the smaller this ratio becomes.
It is now believed that the triglycerides/HDL ratio is one of the most potent predictors of heart disease.
A Harvard-lead study author reported:
“High triglycerides alone increased the risk of heart attack nearly three-fold.
And people with the highest ratio of triglycerides to HDL — the “good” cholesterol — had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL in the study of 340 heart attack patients and 340 of their healthy, same age counterparts.
The citation stated, the ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio.
Gaziano JM, Hennekens CH, O’Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997 Oct 21;96(8):2520-5.