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Cardiovascular

Cholesterol/HDL ratio: the ratio between total cholesterol and HDL cholesterol

Cholesterol is a substance that, according to the NVKC, the Dutch society of clinical chemists, the body uses to build tissues and organs and to make certain hormones and bile acids. According to the NVKC, cholesterol travels in the blood inside lipoproteins, small fat particles of cholesterol, triglycerides and certain proteins: LDL brings cholesterol to the tissues and organs, and HDL carries it away to the liver. The cholesterol/HDL ratio sets total cholesterol against HDL cholesterol, the part the NVKC says is called good cholesterol.

According to the NVKC, cholesterol can deposit in the blood vessels and narrow them there. According to Thuisarts, the Dutch GPs' patient site, high cholesterol gives no symptoms, but when it is too high for years the risk of heart and blood vessel disease is greater. Only a blood test shows the cholesterol/HDL ratio.

According to the NVKC, the cholesterol/HDL ratio should be below 5, and below 3.5 is best.

Doctor's Assessment Included

The cholesterol/HDL ratio is the ratio between total cholesterol and HDL cholesterol. According to the NVKC, the ratio should be below 5, and below 3.5 is best.

  • None of the laboratories Star-SHL, Unilabs and Diagnostiek voor U publishes a limit for the cholesterol/HDL ratio itself; they give limits for cholesterol and HDL cholesterol separately.
  • The NHG no longer estimates cardiovascular risk in SCORE2 with the cholesterol/HDL ratio, but with non-HDL cholesterol.
  • According to the NVKC, the assessment of the cholesterol/HDL ratio should also look at the separate results.

Reference Ranges

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Male Your group
mol/mol
Normal < 5 High
Female Your group
mol/mol
Normal < 5 High

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

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Cholesterol/HDL Ratio: what this test measures

The cholesterol/HDL ratio is the ratio between total cholesterol and HDL cholesterol, two values the laboratory measures separately. According to the NVKC, the total cholesterol test measures both LDL cholesterol and HDL cholesterol without distinguishing between the two forms. Star-SHL, Unilabs and Diagnostiek voor U each give a limit for cholesterol and for HDL cholesterol, but none of the three publishes a limit for the ratio itself.

Cholesterol/HDL Ratio: why this value matters

According to the NVKC, the cholesterol/HDL ratio is a usual way of looking at cholesterol, but according to the NVKC it is very important to look at the results of the separate tests as well. The NHG, the Dutch college of general practitioners, no longer estimates the risk of cardiovascular disease in SCORE2 on the basis of the total cholesterol/HDL cholesterol ratio, but on the basis of non-HDL cholesterol: total cholesterol minus HDL cholesterol. The NHG chooses this because non-HDL cholesterol includes the cholesterol in all apoB-containing, bad lipoproteins.

Cholesterol/HDL Ratio: how the blood test works

Referral
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A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Heart checkup · €209,- · General checkup · €199,-
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Cholesterol/HDL Ratio: when is testing worthwhile?

According to the NVKC, the cholesterol/HDL ratio is preferably measured at least 6 weeks after a pregnancy, because HDL cholesterol is often abnormal in pregnancy. The ratio follows from the lipid profile, which according to the NVKC usually includes total cholesterol, triglycerides and separate HDL and LDL cholesterol. According to the NVKC, for testing all the fats it is important that blood is taken fasting, after 12 hours without eating or drinking, because LDL and triglycerides in particular are strongly affected by food. According to the NHG, non-HDL cholesterol can also be measured non-fasting.

Cholesterol/HDL Ratio: symptoms of a high or low value

Low Levels

The NVKC says a cholesterol/HDL ratio below 3.5 is best. According to the NVKC, a high HDL value is better than a low one, and according to Thuisarts HDL cholesterol may be high, because that is actually good for the blood vessels. According to the NVKC, cholesterol can also be lowered during illness, a few days after a heart attack or with stress.

High Levels

A cholesterol/HDL ratio of 5 or higher falls outside the limit the NVKC gives. According to Thuisarts, high cholesterol gives no symptoms, but when it is too high for years the blood vessels can become blocked and there is a greater risk of, for example, chest pain (angina), kidney damage, peripheral artery disease, a heart attack or a stroke. According to Thuisarts, not everyone with high cholesterol gets these diseases.

Cholesterol/HDL Ratio: causes of a low or high value

What lowers the value

  • Regular exercise

    Regular exercise can raise HDL cholesterol and lower LDL cholesterol.

  • Cholesterol-lowering medicines

    Some cholesterol medicines, including certain statins, can raise HDL cholesterol as well as lowering LDL cholesterol.

What raises the value

  • High total cholesterol

    High cholesterol, the number on top of the ratio, can come from unhealthy eating, being overweight, moving little, some diseases such as a slow thyroid, or many people with very high cholesterol in the family.

  • Smoking

    Smoking and second-hand smoke can lower HDL cholesterol, the number the ratio is divided by.

  • Certain medicines

    In some people, beta blockers, anabolic steroids such as testosterone, progestins in some birth control pills and menopausal hormone therapy, and benzodiazepines can lower HDL cholesterol.

  • Diabetes

    Diabetes can lower HDL cholesterol.

Cholesterol/HDL Ratio: lifestyle and this value

Discuss an abnormal cholesterol/HDL ratio with your GP, because according to the NVKC a correct interpretation needs consultation with the GP. According to Thuisarts, the most important things someone with high cholesterol can do are to stop smoking, eat and drink healthily, move enough, not sit too much, lose weight if overweight, drink no alcohol and reduce stress.

Cholesterol/HDL Ratio: frequently asked questions

What is a good cholesterol/HDL ratio?

According to the NVKC, a cholesterol/HDL ratio below 5 is the limit, and below 3.5 is best. According to the NVKC, the assessment should also look at total cholesterol and HDL cholesterol separately.

Does the GP still use the cholesterol/HDL ratio for cardiovascular risk?

No, in SCORE2 the NHG no longer estimates cardiovascular risk with the cholesterol/HDL ratio, but with non-HDL cholesterol. According to the NHG, SCORE2 applies to people aged 40 to 70 whose risk factors have been roughly stable in recent years, and for ages 70 to 90 there is SCORE2-OP.

Cholesterol/HDL Ratio: sources

  1. MedlinePlus, HDL: The "Good" Cholesterol, U.S. National Library of Medicine, last updated 2026-08-03, geraadpleegd 2026-10-16 (retrieved 2026) medlineplus.gov
  2. Thuisarts.nl (NHG), Ik heb een hoog cholesterol, geraadpleegd 2026-10-16 (retrieved 2026) thuisarts.nl

Test Products

This marker is included in the following test panels.

Heart & vessels

Heart checkup

An extensive blood test with 12 heart and vessel values — the full cholesterol profile, Apo(B), Lp(a), hsCRP, homocysteine and blood sugar — for insight into your heart and vessel health.

Total Cholesterol LDL Cholesterol HDL Cholesterol Non-HDL Cholesterol Cholesterol/HDL Ratio Triglycerides ApoB (Apolipoprotein B) Lipoprotein(a) hs-CRP (High Sensitivity CRP) Glucose (Fasting) HbA1c (Glycated Hemoglobin) Creatinine eGFR (Estimated Glomerular Filtration Rate) LDL/HDL Ratio
€209,-
General checkup

General checkup

A broad blood test covering 18 values across liver, kidneys, thyroid, heart, vitamins and blood count.

ALT (Alanine Aminotransferase) GGT (Gamma-Glutamyl Transferase) Creatinine eGFR (Estimated Glomerular Filtration Rate) TSH (Thyroid Stimulating Hormone) Total Cholesterol HDL Cholesterol LDL Cholesterol Triglycerides Glucose (Fasting) Vitamin D (25-OH) Vitamin B12 Ferritin Hemoglobin Leukocytes (WBC) Platelets (Thrombocytes) CRP (C-Reactive Protein) MCV (Mean Corpuscular Volume) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€199,-

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