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Cardiovascular

Cholesterol/HDL ratio: the old risk measure next to non-HDL cholesterol

According to the NVKC, cholesterol travels through the blood in lipoproteins, small fat particles of cholesterol, triglycerides and certain proteins: LDL, bad cholesterol, brings it to the tissues and organs, and HDL, good cholesterol, carries it away to the liver. The cholesterol/HDL ratio sets total cholesterol against that HDL cholesterol.

Cholesterol can, according to the NVKC, settle in the blood vessels and narrow them, while Thuisarts says high cholesterol causes no symptoms. A blood test is the only way to know the cholesterol/HDL ratio.

The NVKC uses a limit of below 5 for the cholesterol/HDL ratio.

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

Male
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.

Check your own value

Cholesterol/HDL Ratio: what this test measures

The cholesterol/HDL ratio is a ratio, while according to the NHG non-HDL cholesterol is a difference: total cholesterol minus HDL cholesterol. Both come from the same two laboratory values.

Cholesterol/HDL Ratio: why this value matters

The cholesterol/HDL ratio has gone from SCORE2: according to the NHG it uses non-HDL cholesterol instead, because that includes the cholesterol in all apoB-containing, bad lipoproteins, and non-HDL cholesterol can moreover be measured non-fasting. According to the NHG, SCORE2 estimates the ten-year risk of fatal and non-fatal cardiovascular disease in people aged 40 to 70 whose risk factors have been roughly stable in recent years.

Cholesterol/HDL Ratio: how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Cardiovascular Health · €218,- · Metabolic Health Check · €129,- · Men Over 40 Panel · €279,- · Complete Men's Health Panel · €289,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Cholesterol/HDL Ratio: when is testing worthwhile?

According to the NHG, for a risk estimate the GP requests a lipid profile, with LDL cholesterol, HDL cholesterol, non-HDL cholesterol, total cholesterol and triglycerides, from which the cholesterol/HDL ratio also follows.

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

Low Levels

A cholesterol/HDL ratio under 3.5 counts as best for the NVKC, and according to the NVKC cholesterol can also be lowered a few days after a heart attack.

High Levels

According to the NVKC, a cholesterol/HDL ratio of 5 or more is too high. According to Thuisarts, cholesterol that is too high for years gives a greater risk of angina, peripheral artery disease, kidney damage, a heart attack and a stroke, among other things, though 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

Take a cholesterol/HDL ratio that is too high to your GP. Thuisarts lists unhealthy eating, being overweight, moving little, some diseases such as a slow thyroid, and heredity as possible causes of high cholesterol.

Cholesterol/HDL Ratio: frequently asked questions

Why does the NHG look at non-HDL cholesterol instead of the cholesterol/HDL ratio?

In SCORE2 the NHG uses non-HDL cholesterol instead of the cholesterol/HDL ratio, because non-HDL cholesterol includes the cholesterol in all apoB-containing, bad lipoproteins. The NHG adds that non-HDL cholesterol can be measured without fasting.

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.

Prostate

Men Over 40 Panel

Age-appropriate screening including testosterone and PSA.

HbA1c (Glycated Hemoglobin) PSA (Prostate-Specific Antigen) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€279,-
Testosterone

Complete Men's Health Panel

A broad men's health panel: hormones, heart, metabolic, and organ function in one blood draw.

HbA1c (Glycated Hemoglobin) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) Triglycerides Creatinine Glucose (Fasting) Free T4 (Thyroxine) LDL Cholesterol SHBG (Sex Hormone Binding Globulin) Total Cholesterol Vitamin D (25-OH) Free Testosterone Total Testosterone Ferritin hs-CRP (High Sensitivity CRP) HDL Cholesterol eGFR (Estimated Glomerular Filtration Rate) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€289,-

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
CIBG Ministerie van Volksgezondheid,
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