Written by
Louise W Lu, PhD, MPH, BMLS
Written/Reviewed by
Alexandra V Goldberg, Registered Dietitian
Many people feel relieved after a health check when they hear the doctor say, “Your cholesterol ratio (Total Cholesterol / HDL) looks good.”
But did you notice another critical number on your lipid panel — LDL (Low-Density Lipoprotein Cholesterol)?
If your LDL is above 3.4 mmol/L, or even approaching 5 mmol/L, then no matter how “normal” your cholesterol ratio looks, your arteries might already be silently hardening.
It’s not the ratio that clogs your arteries — it’s the absolute value of LDL.
Sometimes, a "good-looking" ratio is just a result of high HDL masking the real problem underneath.
In this article, we’ll uncover the hidden danger behind the cholesterol ratio and explain why the real risk lies not in how good the numbers look — but whether you're looking at the right ones.
Jump to section:
What Is the Cholesterol Ratio — And Why a "Normal" Ratio Doesn’t Mean You’re Safe
Let’s take a look at this lipid profile:
- Total Cholesterol: 7.1 mmol/L (Reference <5.0)
- HDL (Good Cholesterol): 1.70 mmol/L
- LDL (Bad Cholesterol): 4.9 mmol/L (Reference <3.4)
- Triglycerides: 1.2 mmol/L (Normal)
- Total Cholesterol / HDL Ratio: 4.2
Click image to view full size
You’ll notice something interesting: although both total cholesterol and LDL are above the recommended levels, the ratio here still looks “normal” (under 4.5).
That’s often reassuring during health checks — “My doctor said the ratio looks fine, so I guess I’m okay?”
But here’s where the trouble begins.
🔍 How Is This Ratio Calculated?
It’s simply total cholesterol divided by HDL:
Ratio = Total Cholesterol ÷ HDL = 7.1 ÷ 1.7 ≈ 4.2
Looks okay, right? But here’s the issue: this ratio is just a proportion. It doesn’t tell you whether your total cholesterol is too high — or whether your LDL is quietly clogging your arteries.
A “normal” ratio might just be the result of elevated HDL.
To assess real risk, you need to check your actual LDL level.
✅ A Helpful Analogy:
Imagine your house has 4 burglars (LDL) inside, and only 1 security guard (HDL) patrolling. Sure, the 4:1 ratio doesn’t sound terrible — but you still have 4 burglars in the house!
That’s what really matters.
What truly matters is your LDL absolute value.
📌 Summary: How to Read This Report Properly
| Indicator | Safe Range | Interpretation |
|---|---|---|
| Total Cholesterol / HDL Ratio | < 4.5 | Helpful context, but not reliable alone |
| LDL (Bad Cholesterol) | < 3.4 mmol/L | Key metric! High LDL means high risk |
| Total Cholesterol | < 5.0 mmol/L | High level still matters, especially if LDL is also high |
Note: When total cholesterol is elevated, the real danger usually lies in high LDL — it’s the one that sticks to your artery walls.
Even High HDL Can’t Save You If LDL Is Wreaking Havoc
Many people believe: “As long as my HDL is high, it will clean up all the bad LDL.”
But here’s the truth — HDL isn’t an all-powerful cleaner, especially when there’s too much LDL or when LDL is in the wrong form.
Your body’s cholesterol transport works like a logistics network:
- LDL is the delivery truck that sends cholesterol to your tissues.
- HDL is the recycling truck that takes the excess back to the liver.
Here’s the problem:
When there’s too much LDL, or the particles are too small (especially “small dense LDL” or sdLDL), they’re more likely to get stuck in your artery walls, trigger inflammation, and form plaques — leading to atherosclerosis.
In that case, even if HDL is high, it might not be able to keep up with the damage.
And more importantly, some people have high HDL but “poor functionality” — meaning it can’t do its job of removing cholesterol. It’s just busywork with no effect.
Click image to enlarge
🔶 Key takeaway: HDL helps, but it’s not the main player.
Managing LDL is what truly protects your arteries.
LDL Management: Why High-EPA Fish Oil and Milk Thistle Work
We now understand that when LDL is too high, small (especially small dense LDL, or sdLDL), or oxidized, it tends to wreak havoc in our arteries—triggering inflammation, forming plaques, and leading to atherosclerosis.
So the question is: Beyond diet, what else can we do?
✅ High-EPA Fish Oil: Make LDL Less Dangerous
Many people think fish oil is for “lowering cholesterol,” but that’s not its main value. The true power of fish oil lies in reducing the harmful impact of LDL—not just its number.
Especially fish oils with high EPA (Eicosapentaenoic Acid) and minimal or no DHA have been clinically validated to:
- Transform LDL particles to become larger and fluffier, shifting from “small and dense” to “large and buoyant”;
- Significantly lower triglycerides, easing liver lipid processing burden;
- Reduce inflammation and protect blood vessel lining, preventing plaque triggers.
DHA is great for the brain, but in some people, it may raise LDL levels.
🔍 Recommended High-EPA Fish Oil Products
| Product | EPA Content | Highlights | Recommended For | Link |
|---|---|---|---|---|
| NYO3 97% EPA Fish Oil | 600mg / capsule | Zero DHA; ultra-pure EPA formula ideal for high triglyceride management | Those with high LDL, high TG, or atherosclerosis risk | Shop now |
| Saintstar EPA1000 | 1000mg EPA / capsule | Powered by German KD Pharma EPA; larger capsule for higher needs | People with cardiovascular history needing rapid support | Shop now |
| PNZ 1440 EPA Fish Oil | 1060mg EPA / capsule | High EPA + low DHA combo; gentler and easier to absorb | First-time users, sensitive to taste, long-term wellness users | Shop now |
✅ Milk Thistle: Boost Liver’s LDL Clearance
Milk thistle (Silymarin) isn't a “lipid-lowering agent,” but it’s a hidden star in LDL management:
- Activates liver LDL receptors (LDL-R), enhancing LDL clearance;
- Reduces LDL oxidation, preventing it from turning “bad” in arteries;
- Especially helpful for people with weak liver function or fatty liver tendency.
🔍 Recommended Milk Thistle Products
| Product | Silymarin Content | Highlights | Recommended For | Link |
|---|---|---|---|---|
| PNZ Liver Support | 180mg silymarin / capsule | Siliphos® patented complex with milk thistle + choline + artichoke | People with weak liver function or elevated ALT | Shop now |
| NYO3 Liver Detox | 400mg silymarin (high-purity silybin) / capsule | Danish raw material, plant-based vegan capsule | Vegetarians, clean-label ingredient seekers | Shop now |
| HealthLife Milk Thistle | 300mg / capsule | High-strength extract; budget-friendly daily support | General maintenance, cost-conscious users | Shop now |
In summary:
High-EPA fish oil + Milk Thistle = Less dangerous LDL + Faster clearance.
It’s not just about lowering cholesterol numbers—it’s about truly reducing cardiovascular risk.
