Is your HDL cholesterol ratio telling you that a heart attack might be right around the corner for you?
Let’s go over some of the misconceptions aboutthis HDL ratio number you see. There’s a lot of confusion and misunderstanding when it comes to both calculating and interpreting what the HDL cholesterol ratio is and what it means now you can calculate your ratio in one of two different ways the first way is just take your HDL / your LDL so the HDL is the numerator in this equation the second way is the is to flip it around so that the LDL numbers on top and one since it doesn’t matter how you calculate it but as I’m sure you can tell by this formula how you calculate it totally changes what is and what isn’t a good or bad ratio number so for example if you take the HDL as the numerator in this formula you want a higher ratio and the flip side of that is if you put the LDL number on top as the numerator you want a lower ratio so what’s happening is some people are are doing calculated this ratio then they’re looking at a chart and the chart is based on numbers as if the formula was flipped so you’ve got to make sure that your matching up how you calculate it with the proper chart so what I want you right now is is visit this page right now to see what your ratio means and better yet how you can improve this vitally important ratio to reduce your risk of a heart attack or heart disease 
There are four basic components to cholesterol panel – the total cholesterol, HDL, LDL and triglycerides of which the total cholesterol is the least important of the bunch.
You want to be less than 200 for your total cholesterol, but, you’re going to quickly move down to the next couple of lines the HDL and LDL cholesterol the HDL cholesterol is your good cholesterol you want to have more of that and an easy way to remember thatis each for happy or h4 you wanted higher so a minimum hdl-cholesterol for a man would be 40 and for a woman would be 46 so you want to be greater than those numbers a way to quantify a low hdl-c your 35 is a man how bad is that for you every one point of HDL below 40 or your target equates to an extra two percent increase risk of heart attack or stroke
if you had a group of 200 people in one room there was a hundred people they were exactly like you your HDL was 35 everything else blood pressure cholesterol smoking family history diabetes everything was exactly the same the other group of people the HDL was 40 but everything else was the same the group that had the HDL of 35 would have an overall ten percent increase risk of heart attack as compared to the group of 40 so that’s what an independent risk factor is it’s independent of all the other risk factors so very significant even getting a two or three point increase in your HDL equates to a significant decrease in risk of heart attack and stroke
The next component would be your LDL that’s the bad cholesterol and you can remember L for you want it lower or l4 lousy and there’s three different targets we use if you’re completely healthy we will use an LDL cholesterol of less than 130 would be acceptable so you have no other risk factors for heart disease if your LDL is a hundred goal that’s when you have one or two risk factors so say you’re a smoker and you have high blood pressure or you have a family history of heart disease and you’re overweight so we add up you’ve got to risk factors for heart disease additional risk factors so we’re going to recommend an LDL less than 100 most people probably should be less than a hundred than the most stringent reduction of the stringent goal would be for an LDL less than 70 and those are people that have pre-existing heart disease so if you had a heart attack already if you had bypass surgery if you have any angioplasty so you didn’t actually have a heart attack but you’ve got documented heart disease or if you’re a diabetic we want your LDL less than 70
As an interesting note diabetes is what’s called a cardiovascular risk equivalent which means if you’re a diabetic and you’re sitting at lunch with someone who’s already had a heart attack both you and the person who’s already had a heart attack have an equal risk of having a heart attack so a cardiovascular risk equivalent diabetics are too greatly increased risk of heart disease so we want their LDL beautiful as well at less than 70 lastly is the triglycerides and triglycerides is basically circulating fat it’s kind of an accounting trick when you eat a meal your body doesn’t use it right away it turns it into triglycerides and telekinesis burn the calories is energy it can store it is fat or it can turn into glycogen or sugar to be stored in your muscles people have a variable ability to convert their meal into triglycerides and then clear it from the bloodstream and that’s actually part of metabolic syndrome which we talked about before if you’ve ever seen triglycerides in blood I worked at a blood bank in college we would have big bags of blood not little tubes of blood and you would separate the red blood cells from the serum and the red blood cells were dark red and that would sit at the bottom of the bag and the top half of the bag would be this yellow we clear almost look like urine that’s your serum of the water that the blood is circulating are mixed in if you have high triglycerides
If you can imagine taking a glass of milk putting ice cubes in it letting the ice melt and then giving it a light swirl that milk swirly appearances actually fat in your bloodstream so we would have blood donations on people after lunch and their blood with literal be cloudy thick with fat and it’s pretty disgusting and obviously not going to be healthy for you to have sort of fat flowing through your blood streams that’s triglyceride so we check a triglyceride level if it’s not fasting that may be elevated because you’ve just eaten so that’s reasonable but after an eight or twelve our typical fast you should have your triglycerides less than 150 so triglycerides are circulating fat think of the milk and ice cube swirled that’s gross your HDL think of HDL cholesterol is garbage trucks in your LDL cholesterol is garbage on the street so if we have a low amount of garbage trucks are HDL is low then we need to have a lower amount of garbage if we have a very high HDL reater than 60 that’s actually a minus
risk factor for protective and we can tolerate a slightly larger amount of LDL if we have high triglycerides if we have low HDL cholesterol and a perhaps a normal total cholesterol is sometimes difficult to interpret what a normal number should be going from blood test a blood test if one goes up and one goes down what you can do there’s a couple of things that will use one as what’s called a cholesterol HDL ratio so if you divide your total cholesterol by your HDL so your total is 210 HCL’s 40 that’s a cholesterol HDL ratio of five we want to target that to be about three-and-a-half four below that means you’re in a lower risk of heart disease another thing that we can do is what’s called nine hdl-cholesterol this was a recent invention or recent recommendation because we’re seeing a lot more people with elevated triglycerides and that’s an unusual phenomenon are used to be unusual but now it’s fairly common and that can make interpreting the blood cholesterol panel difficult so we do what’s called a non-hdl cholesterol so that is your total cholesterol minus your HDL so if your total cholesterol was 200 and your HDL was 40 again than your non-hdl cholesterol is a hundred and sixty and we use a recommendation of 30 points greater than whatever our LDL target is so if our LDL goal was 130 would say non-hdl could be a hundred and sixty-four LDL target for someone with heart disease was hot it was 70 that we want a non-hdl of less than a hundred so those are different factors we can use when we have an abnormality in her blood or we have a significant variance from one lipid panel to the next to see how we’re doing whether we’re better or worse an additional tests that you can do if we’re not sure if we’re on the fence and I say boy I think I might want to put you on cholesterol medication but your numbers are kind of close or maybe a little younger and I’m saying you’re kind of young to go on cholesterol medicine and 35 we can do what’s called a cardio CRP or an hs-crp high sensitivity or heart specific CRP and what that is is a marker of blood vessel inflammation if you have an elevated CRP of greater than three you have a two-and-a-half to three fold increased risk of heart attack or stroke so another independent risk factor above and beyond everything else if your CR p is greater than three you have a high likelihood of dying of heart disease if your CR p is less than one then you have a very low risk of heart disease and a way to think of how we interpret this would be as if you came in at 35 or 40 and your cholesterol was high and I was thinking about putting on medication and I ask a family history and if everybody live to a hundred and your family I would be less inclined to put on medications because you obviously have some good genetics if you told me that everybody in the family died at 42 of a heart attack you obviously have some bad genetics going on and I would treat you much more aggressively so that’s a way that we can do CRP so I generally don’t do CRP we don’t treat it specifically but we use that in addition to your other risk factors and determine what our overall risk as an undetermined our threshold for putting you on cholesterol medication so lengthy topic very easy if we go back to the basics total cholesterol less than 200 at least important in DC hdl-cholesterol greater than 40 in a man and greater than 46 and a woman most likely our best in to see of heart disease ldl-cholesterol less than 1 30 100 or 150 ending and who you are easily treatable with cholesterol medication and then I triglyceride less than 150 that’s part of metabolic syndrome and usually diabetes or pre-diabetes related dr. Greg Costello thanks
