Total Cholesterol/HDL Ratio
The total cholesterol to HDL ratio compares overall cholesterol burden with protective HDL and is used as a summary cardiovascular risk index. Lower ratios suggest a healthier lipid balance, while values above 5 indicate elevated risk. The ratio is part of several cardiovascular risk calculators and can be followed to monitor treatment response alongside LDL or ApoB.
Optimal range: who says what
Institutions, researchers and practitioners draw the line in different places. Each position is listed with who holds it and, where a document states it, a link. How we verify ranges.
- Institution or studyLower is betterCastelli, Abbott & McNamara 1983 (Circulation)The total/HDL and LDL/HDL ratios were strong predictors of coronary heart disease, though a single ratio is not always as informative as the cholesterol values that make it up
- Named practitioner<3.5Life Extension · Lab Testing Protocol (Suggested Optimal Ranges)Disclosure: Life Extension sells lab panels that appear in our blood-test comparisons.
- Lab reference intervalNo established lab reference interval (calculated ratio)What a lab report flags against. A lab interval is not an optimal target.
Practitioner targets are individual positions, often tighter than guideline ranges. Each was checked against its article before publishing.
7 of 21 itemized panels
Lipid Panel / Cardiovascular Health
Why Total Cholesterol/HDL Ratio matters
A key indicator of cardiovascular disease risk. Lower ratios indicate better heart health because HDL helps remove cholesterol from arteries. Optimal is below 3.5; above 5.0 indicates elevated risk.
Reading a Total Cholesterol/HDL Ratio result
The ratio is total cholesterol divided by HDL cholesterol. It rises when total cholesterol goes up or HDL goes down, so check which input moved. MedlinePlus targets for the inputs: total cholesterol below 200 mg/dL, and HDL of 60 mg/dL or higher (above 40 for men and 50 for women is the healthy minimum).
What pushes it up
- Smoking, which lowers HDL
- Overweight, especially fat around the waist
- Low physical activity
- Diabetes, which can lower HDL
- Medicines that lower HDL: beta-blockers, anabolic steroids including testosterone, progestins, benzodiazepines
- A diet high in saturated fat, or an inherited lipid disorder
What brings it down
- Stopping smoking and avoiding secondhand smoke
- Regular aerobic exercise
- Losing weight
- Replacing saturated and trans fats with unsaturated fats
What to check next
- Total cholesterol and HDL individually, to see which one moved
- ApoB or non-HDL cholesterol for atherogenic particle burden (ARUP)
- Blood glucose, kidney function and thyroid tests when lipids are abnormal (MedlinePlus)
Sources: MedlinePlus: High blood cholesterol levels; MedlinePlus: HDL, the good cholesterol; ARUP Consult: ASCVD risk assessment. Checked against these sources 2026-09-23. General information, not medical advice; your lab's reference interval and your clinician's reading take precedence.
Which Providers Test Total Cholesterol/HDL Ratio?
Cheapest: Oura Health Panels at $99/year. Most comprehensive: Empirical Health, 100+ biomarkers for $190/year.
7 panels that include it, cheapest first
| Provider | Annual Cost | Total Biomarkers | $/Biomarker |
|---|---|---|---|
| $99 | 50 | $1.98 | |
| $190 | 100+ | $1.90 | |
| $297 | 100+ | $2.97 | |
 Superpower | $349 | 100+ | $3.49 |
| $349 | 75+ | $4.65 | |
 WHOOP Advanced Labs | $349 | 65 | $5.37 |
| $499 | 100+ | $4.99 |
$/Biomarker is annual cost divided by the panel's advertised biomarker count, not the price of this one test. We track 23 blood test providers (32 plans); 21 of those plans are itemized marker by marker. Compare all of them.
14 itemized panels do not include Total Cholesterol/HDL Ratio
Labcorp OnDemand · Life Extension Elite · Everlywell · InsideTracker · Function Health · Marek Health Base · Marek Health Comprehensive · Marek Health Complete · Marek Health Executive · Blueprint · SiPhox Health · Healthspan · Vitality Blueprint Standard · Vitality Blueprint Elite
11 providers not itemized in our matrix
We have not itemized these marker by marker (some sell tests one at a time), so this page cannot say whether they offer Total Cholesterol/HDL Ratio. Check with them directly.
Life Extension Standard · Quest Health · Ultrahuman Blood Vision · Lifeforce · Hundred Health · Personalabs · Walk-In Lab · HealthLabs · WHOOP Specialized Panels · Marek Health Essential · Vitality Blueprint Upload
Frequently Asked Questions
What is the optimal range for Total Cholesterol/HDL Ratio?
Published position: Lower is better (Castelli, Abbott & McNamara 1983 (Circulation)). Named practitioners target: <3.5 (Life Extension). No established lab reference interval (calculated ratio).
Which blood test providers include Total Cholesterol/HDL Ratio?
7 of the 21 blood testing panels we itemize marker by marker include Total Cholesterol/HDL Ratio in their panels. This biomarker is widely available across major providers.
Related: YouBoost rates lifestyle and supplement interventions by evidence; HRV Zone tracks recovery trends.
Medical Disclaimer
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
Last reviewed Sep 23, 2026 · First published Nov 30, 2025