Heart and cholesterol
Total cholesterol to HDL ratio
Cholesterol/HDL ratio, TC/HDL-C
Included in every MyHealthspan membership: Focus, Baseline, and Complete.
Compare membershipsTotal cholesterol and HDL, combined in one number.
The TC/HDL ratio is calculated by dividing your total cholesterol by your HDL cholesterol. It shows how your total cholesterol compares with the cholesterol carried in HDL, the particles that help carry cholesterol back to the liver.
This ratio captures more than LDL alone.
Total cholesterol includes the cholesterol in triglyceride-rich particles, which LDL cholesterol leaves out. That's why this ratio can reflect risk that the LDL/HDL ratio may miss when triglycerides are high.
It's still a calculated summary. Canadian guidelines use LDL cholesterol, non-HDL cholesterol, or ApoB to guide treatment, and the Framingham Risk Score used in Canada takes total cholesterol and HDL as two separate inputs. This ratio is best read as context alongside those results.
A higher ratio means less HDL relative to everything else.
Questions
What does a higher ratio mean?
A higher ratio means more of your cholesterol is in particles that can contribute to plaque, relative to HDL. It's linked with higher cardiovascular risk, and a clinician reads it with your other results, blood pressure, and health history.
Why might my ratio change when my total cholesterol doesn't?
The ratio depends on HDL too. If HDL falls while total cholesterol stays the same, the ratio rises. Physical activity, body weight, smoking, and some medications can all shift HDL.
Sources and references
- Millán et al., Lipoprotein ratios: physiological significance and clinical usefulness (Vasc Health Risk Manag, 2009)
- Canadian Cardiovascular Society, 2021 dyslipidemia guidelines (Pearson et al., Can J Cardiol)
- MedlinePlus, Cholesterol levels (U.S. National Library of Medicine)
- Canadian Cardiovascular Society, Framingham Risk Score calculator