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What You’ll Learn:
- Why people with high HDL still have heart attacks
- The difference between HDL quantity and HDL function
- Conditions that cause dysfunctional HDL
- Why the Trig:HDL ratio is a practical proxy for HDL quality
- How to test numerous cholesterol markers at once
You’ll notice that Choose Health blood tests measure a variety of markers. That’s because we know single marker measurements can be incomplete. It’s when you look at various markers in combination or in comparison that you get a better idea of how your body is functioning.
High-density lipoprotein (HDL) cholesterol is the perfect example. It’s been called the “good cholesterol”, but that’s not necessarily true. A person can have high HDL cholesterol and still have a heart attack.
This is possible because the HDL cholesterol count doesn’t tell you if it’s doing its job.
Every cell contains cholesterol that can either be high-density or low-density lipoprotein (LDL). Generally, the HDL cholesterol doesn’t stick around in arteries. HDL particles clear out cholesterol so that it doesn’t build up in the arteries.
Having high HDL cholesterol is correlated with lower heart disease risk, but there’s a catch. The count isn’t a measure of function. The HDL particles might not be clearing cholesterol as expected.
This was discovered in a series of clinical trials using a medication that would dramatically increase HDL. The theory was that the higher HDL went the lower heart disease risk would be. That theory didn’t pan out. It became clear simply raising HDL levels wasn’t the solution. HDL quantity doesn’t indicate HDL quality.
And since that was the case, it meant HDL count on its own wasn’t the ideal benchmark metric. Another measurement that accounts for dysfunctional HDL is the solution.
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Conditions That Create Dysfunctional HDL
There are certain conditions that can change the way HDL particles behave. Instead of clearing out cholesterol, dysfunctional HDL starts collecting in arteries. The most common reasons for HDL dysfunction are:
- Chronic inflammation
- Metabolic dysfunction
- Oxidative stress
- Insulin resistance
- Diet high in refined carbohydrates
On a standard cholesterol test, the HDL measurement won’t be able to point out the discrepancy. Normal and dysfunctional HDL are all counted the same so you won’t know for sure how well it’s cholesterol is being cleared out of your arteries.
Why the Trig:HDL Ratio is a Better Indicator of HDL Quality
You want to know your HDL number, but that’s just part of the equation. Knowing your fasting triglyceride count is also needed to determine your triglyceride-to-HDL ratio.
Triglycerides are a measurement of the fat content that’s circulating in your blood. When triglycerides are high it indicates certain conditions that lead to HDL dysfunction.
Dividing your triglycerides by the HDL tells you:
- Insulin resistance
- The size of LDL particles
- General idea of metabolic health
All of these factor into the function of HDL particles. It tells you both the quantity and quality of HDL cholesterol for a more accurate gauge of how healthy your arteries are.
Trig:HDL Ratio Ranges
If your test reports HDL and triglycerides in mg/dL (standard in the US) here are the ranges:
Best Test Practices For Measuring Cholesterol Markers
You know the metrics to test and the ranges, but there are some things to keep in mind as you continue managing your cholesterol levels.
Test Regularly to Track Trig:HDL Ratio Over Time
As you age your cholesterol can change in response to diet, lifestyle adjustments, medications and health conditions. It’s a moving target, which means it’s a good idea to track the metrics regularly. That way you know if the ratio is increasing, decreasing or remaining steady. How the numbers are trending will tell you a lot about your cardiovascular health and help you intervene early on if cholesterol becomes an issue. Plus, you can know for sure how much of a difference dietary and lifestyle changes make in terms of improving cholesterol.
Test Every 2+ Months
Changes to triglycerides can happen quickly and are responsive to diet, but HDL moves more slowly. The general recommendation is to give it 2-3 months before retesting. If your Trig:HDL ratio is good, you aren’t experiencing any symptoms and you aren’t making any lifestyle changes you can wait 6-12 months to test again.
Test at Home For Convenient Tracking
You don’t have to schedule a doctor's visit and wait weeks or months just to take cholesterol tests. Choose Health offers at-home blood tests that measure HDL, LDL and triglycerides so you have all the numbers you need from a single finger prick. Our tests are analyzed by CLIA/CAP accredited labs to produce results that are on par with testing at a clinic.
Choose Health gives you all the information you need to figure out the quantity and quality of your HDL cholesterol. The full cholesterol panel is available through several at-home tests including the Cardiovascular Test, Core Metabolic Test and Comprehensive Metabolic Test.
Knowing your HDL cholesterol isn’t meaningless information. It’s simply incomplete information that doesn’t tell you about function. High HDL can be reassuring, but the Trig:HDL ratio is enlightening. The best part is that with a full lipid panel test you can get all the metrics at once without a referral from a doctor.
All four values you need - HDL, triglycerides, LDL and total cholesterol - in a single finger-prick test. Calculate your Trig:HDL ratio at home, track it over time and get a genuinely accurate read on your metabolic health. No clinic visit. No waiting room. No gaps in the measurements.
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