Cholesterol : HDL

Introduction

As a functional medicine nurse practitioner in Florida, I emphasize the importance of key cardiovascular biomarkers. The Cholesterol: HDL ratio provides a more precise estimate of cardiovascular function risk than total cholesterol alone.

Background on Cholesterol and HDL

• Cholesterol is a vital lipid for cell membranes, hormones, and vitamin D synthesis.
  
• High-density lipoprotein (HDL) is “good cholesterol,” transporting excess cholesterol from arteries back to the liver.
  
• The Cholesterol: HDL ratio divides total cholesterol by HDL, yielding a metric where lower is better.

   

Ideal Cholesterol:HDL Ratio

• Standard Range: 0.00–5.00
  
• Optimal: < 3.0
  Every 1-point increase in this ratio raises heart attack risk by ~60%.

   

Clinical Implications

Low Ratio

A ratio under 3.0 indicates robust HDL relative to total cholesterol, correlating with low atherosclerotic process risk.

High Ratio

A ratio above 5.0 signals disproportionate cholesterol to HDL and is linked to:

• Accelerated plaque buildup (atherosclerotic process)
  
• Elevated risk of heart attack and stroke
  
• Underlying dyslipidemia

   

Factors Affecting the Ratio

Lifestyle and Interfering Factors

• Diet: High saturated/trans fats increase total cholesterol.
  
• Exercise: Regular activity raises HDL.
  
• Smoking: Lowers HDL, worsening the ratio.
  
• Alcohol: Moderate intake may boost HDL; excess harms lipids.

   

Drug Associations

• Improvement (↓ ratio):
  
  • Statins (e.g., atorvastatin)
    
  • Fibrates (e.g., fenofibrate)
    
• Worsening (↑ ratio):
  
  • Beta-blockers (can lower HDL)
    
  • Anabolic steroids (significantly reduce HDL)

     

Strategies to Optimize Your Cholesterol:HDL Ratio

Dietary Adjustments

• Increase soluble fiber: Oats, beans, fruits
  
• Choose healthy fats: Olive oil, avocados, nuts
  
• Add omega-3s: Fatty fish, flaxseeds, walnuts

   

Lifestyle Modifications

• Exercise: Aim for 150 minutes/week of moderate cardio
  
• Quit smoking: Improves HDL within weeks
  
• Moderate alcohol: One drink/day may boost HDL

   

Medical Interventions

When lifestyle alone isn’t enough, medications like statins or fibrates—prescribed under guidance—can significantly improve the ratio.

Conclusion

Monitoring your Cholesterol: HDL ratio is essential for proactive cardiovascular care. As a functional medicine practitioner, I integrate this biomarker with personalized nutrition, movement, and, when needed, therapies like regenerative medicine to address root causes and optimize heart health.

Further Reading

1. LaRosa, J. C. (1990). At what levels of total low- or high-density lipoprotein cholesterol should diet/drug therapy be initiated? United States guidelines. American Journal of Cardiology, 65(12), 7F-10F. https://pubmed.ncbi.nlm.nih.gov/2180270/6

2. deGoma, E. M., & Rader, D. J. (2014). Current guidelines for high-density lipoprotein cholesterol in therapy and future directions. Vascular Health and Risk Management, 10, 205–216. https://pmc.ncbi.nlm.nih.gov/articles/PMC3986285/7

3. Reiner, Z., Catapano, A. L., De Backer, G., Graham, I., Taskinen, M. R., Wiklund, O., … & Wood, D. (2011). ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal, 32(14), 1769–1818. https://www.lipid.org/sites/default/files/6-_guideline_overview-_jones.pdf5

4. Barter, P. J., Rye, K. A., & Tardif, J. C. (2001). Treating patients with low high-density lipoprotein cholesterol. Canadian Medical Association Journal, 164(10), 1431–1436. https://pmc.ncbi.nlm.nih.gov/articles/PMC59631/