LDL / HDL Ratio
Your LDL cholesterol divided by your HDL cholesterol. Some labs print it as one number that compares the 'bad' and 'good' cholesterol you carry.
AI-drafted. Awaiting verificationAlso called LDL/HDL, LDL:HDL, LDL-C/HDL-CLOINC 11054-4
Check your result
The usual range for LDL/HDL Ratio depends on sex. Choose female or male above to see where you stand.
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What it is
This ratio is simple division: LDL cholesterol divided by HDL cholesterol, with both numbers in the same unit. A ratio of 2 means your LDL is twice your HDL. Your lab works it out for you, and it has no unit. A lower ratio means less of your cholesterol sits in LDL compared with protective HDL.
Why it matters
A ratio can show something that LDL alone hides. A person with a high-looking LDL and a high HDL can have a lower ratio than someone with a normal LDL and a low HDL. A 2009 review concluded that ratios that include HDL predicted heart disease better than LDL cholesterol alone in several large studies, and that the risk linked to a high ratio was considerably higher in people who also had high triglycerides. Current US guidelines focus on LDL and non-HDL cholesterol instead, and a 2026 Circulation review says they do not use lipid ratios to guide treatment. So the ratio works best as a supporting number.
If it’s low
A lower ratio is generally seen as favorable. It usually means LDL is low, HDL is high, or both. A low ratio on its own does not usually need action, and your clinician can look at it with your other results. Rarely, a very low LDL without treatment comes from an inherited condition or another illness.
Common causes
- A low LDL cholesterol, for example from cholesterol-lowering treatment or a diet low in saturated fat
- A high HDL cholesterol
- Regular exercise, which raises HDL in some people
If it’s high
A higher ratio means LDL cholesterol is large compared with HDL cholesterol. That can happen because LDL is high, HDL is low, or both. Higher ratios are linked to a greater chance of heart disease over time. The ratio alone can't show which part is driving it, so your clinician will look at the pieces.
Common causes
- High LDL cholesterol, which can come from a diet high in saturated fat, genes (including familial hypercholesterolemia), an underactive thyroid and other conditions
- Low HDL cholesterol, which often goes with little physical activity, smoking, extra weight, insulin resistance or type 2 diabetes
- High triglycerides, which often travel with low HDL
- Some medicines, such as anabolic steroids, which can lower HDL
What can help
- Be active most days. Physical activity can lower LDL cholesterol and triglycerides and raise HDL cholesterol
- If you smoke, ask your clinician about help quitting
- Work toward a healthy weight and eat more vegetables, fruit, whole grains and nuts, with less saturated fat
- Ask your clinician whether to follow this ratio, your LDL, or your non-HDL cholesterol over time
- Ask how your result fits with your overall heart risk
Usual ranges
What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.
The usual range depends on sex. Choose women or men to see the one that applies.
- Menup to 4.9 ratio
- Womenup to 4.12 ratio
See LDL/HDL Ratio by age and sex, with the U.S. survey numbers where they exist.
Wellness targets
Narrower ranges some clinicians aim for. Being outside one doesn’t mean something is wrong.
up to 2.99 ratio (Men). Evidence: Expert opinion. A 2009 review (Millan et al.) proposed an LDL/HDL target below 3.0 for men without heart disease, and below 2.5 after a heart event. It is an expert proposal built on observational data, and US guidelines set no target for this ratio.
up to 2.49 ratio (Women). Evidence: Expert opinion. A 2009 review (Millan et al.) proposed an LDL/HDL target below 2.5 for women without heart disease, and below 2.0 after a heart event. It is an expert proposal built on observational data, and US guidelines set no target for this ratio.
Quest LDL/HDL ratio risk groups, men (Quest prints two decimals)
- Below average riskbelow 2.29 ratio
- Average risk2.29 to under 4.91 ratio
- Moderate risk4.91 to under 7.13 ratio
- High risk7.13 and above ratio
Quest LDL/HDL ratio risk groups, women (Quest prints two decimals)
- Below average riskbelow 2.35 ratio
- Average risk2.35 to under 4.13 ratio
- Moderate risk4.13 to under 5.57 ratio
- High risk5.57 and above ratio
How common is your level?
NHANES describes the US civilian, non-institutionalized population, not a 'healthy' reference group. People with disease, on medication, fasting or not (except fasting-subsample markers), smokers and so on are all included. A percentile says where a value sits among Americans of that sex and age, not whether it is normal.
Use the left and right arrow keys to read each age. Shift moves five years.
Reference data derived from CDC/NCHS National Health and Nutrition Examination Survey (NHANES), cycles 2015-2016, 2017-March 2020 (pre-pandemic), August 2021-August 2023. Analysis by bloodtesttracker.com; not endorsed by CDC, NCHS or HHS.
Explore LDL/HDL Ratio by age and sex: every percentile as a table, with a download.
What can affect your result
- Anything that changes LDL or HDL cholesterol changes the ratio
- How LDL was measured: calculated LDL is less reliable when triglycerides are very high or LDL is very low
- Fasting: Quest asks for 9 to 12 hours for its panel with ratios, while a standard lipid panel often doesn't need it. Follow your lab's instructions
- Physical activity, smoking, body weight and diet
- Diabetes, thyroid, kidney and liver conditions, and some medicines
- Rounding can make the ratio on your report differ slightly from the one you work out yourself
- Lab cutoffs differ, so compare your result with the range on your own report
- The ratio comes from two separately measured numbers, so an error in either one carries into it.
- If LDL is calculated, the ratio inherits the limits of that calculation, especially when triglycerides are very high or LDL is very low. Labcorp does not calculate LDL cholesterol when triglycerides are above 800 mg/dL.
- Quest asks for a 9 to 12 hour fast for its Lipid Panel with Ratios. A 2026 Circulation review notes that a standard lipid panel does not require fasting, so follow the instructions your lab gives you.
- Quest notes that treatment with N-acetylcysteine (an acetaminophen-overdose medicine) can make a cholesterol result read falsely low, and so can a blood draw during or right after an injection of the painkiller metamizole.
About 4 to 12 weeks for LDL to respond to diet or treatment. HDL changes more slowly and only a little.
When to talk to a clinician
Talk with a clinician if your ratio is above the range on your report, especially if you also have diabetes, high blood pressure, a family history of early heart disease, or you smoke. This number can't tell you whether you have heart disease. If you have chest pain or pressure, trouble breathing, or signs of a stroke such as face drooping, arm weakness or trouble speaking, call 911 or your local emergency number, whatever your results are.
Questions you could ask
- Should I follow this ratio, my non-HDL cholesterol or my LDL over time?
- Is my ratio high because my LDL is high, my HDL is low, or both?
- Which cholesterol number do you use to track my heart risk?
- What changes would help most to lower my LDL or raise my HDL?
- Is a low ratio explained by my treatment or by a high HDL?
Questions people ask
What is a good LDL/HDL ratio?
A lower ratio is generally seen as more favorable. Quest labels a ratio under about 2.3 as below average risk and up to about 4.9 for men (4.1 for women) as average risk. A 2009 review suggested a target under 3.0 for men and 2.5 for women who haven't had heart disease. US guidelines set no ratio target, so your clinician may focus on LDL or non-HDL cholesterol instead. Check the range printed on your own report.
How is the LDL/HDL ratio calculated?
Divide your LDL cholesterol by your HDL cholesterol, using the same unit for both. For example, an LDL of 100 mg/dL and an HDL of 50 mg/dL gives a ratio of 2.0. The ratio has no unit, so it is the same number in mg/dL and mmol/L.
Is the ratio better than LDL cholesterol alone?
A 2009 review concluded that the LDL/HDL and total cholesterol/HDL ratios predicted heart disease better than LDL alone in several studies. But current guidelines set goals for LDL and non-HDL cholesterol, not for the ratio, so your clinician may use the ratio only as a supporting number.
Show the science and sources
For clinicians and researchers
The ratio is LDL-C divided by HDL-C. Both terms share a unit, so it is dimensionless and numerically identical in mg/dL and mmol/L; LOINC separates a mass ratio (11054-4) from a molar ratio (44915-7). It carries the analytic and biological variation of both terms and any bias in the LDL-C method (Friedewald, Martin-Hopkins, NIH equation or direct assay). Quest prints sex-specific groups on its Lipid Panel with Ratios: below average risk under 2.28 (men) and 2.34 (women), average risk 2.29-4.90 and 2.35-4.12, moderate risk 4.91-7.12 and 4.13-5.56, and high risk above 7.13 and 5.57. A 2009 review proposed primary-prevention risk levels above 3.5 (men) and 3.0 (women) with targets below 3.0 and 2.5, and secondary-prevention levels above 3.0 and 2.5 with targets below 2.5 and 2.0. It found no conclusive evidence that the total/HDL ratio outperforms the LDL/HDL ratio or vice versa. In the Helsinki Heart Study and PROCAM, an LDL/HDL ratio above 5 marked high risk, and the highest risk was in people with a ratio above 5 and triglycerides of about 200 mg/dL or more. The review also notes that the LDL/HDL ratio may understate the lipoprotein abnormality when triglycerides are high, because VLDL cholesterol is not counted in LDL. A 2026 Circulation review states that current guidelines do not use lipid ratios to guide therapy or risk assessment.
LOINC 11054-4 (primary), 44915-7. Specimen: calculated.
Sources
- Lipid Panel with Ratios, Quest Diagnostics (reference ranges as listed by Fullscript), Quest Diagnostics (via Fullscript)
- Lipoprotein ratios: physiological significance and clinical usefulness in cardiovascular prevention, Vascular Health and Risk Management (2009)
- Lipid Profile Testing and Interpretation (summarizes the 2026 ACC/AHA Dyslipidemia Guideline), Circulation (Nguyen, Ahmad, Navar) (2026)
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary, Circulation (2018)
- Blood Cholesterol: Treatment (lifestyle changes), National Heart, Lung, and Blood Institute
- NMR LipoProfile With Lipids (With Graph) (test 123810), Labcorp
AI-drafted. Awaiting verification. Last reviewed 2026-10-03. How we build and check these pages.