I had no idea what my cholesterol numbers actually meant until I started digging into them myself. My doctor would say the number was high and I'd nod along — but I didn't really understand what I was looking at.
Turns out, the total number is kind of the least interesting part.
Here's what total cholesterol actually is
Total cholesterol is the sum of all cholesterol particles in your blood — LDL, HDL, VLDL, all of it added together into one number.
The problem: HDL is protective. Raising your HDL improves your cardiovascular picture. But it also raises your total cholesterol number. So a person with genuinely excellent cholesterol health can have a "high" total — and someone at real risk can have a number that looks perfectly fine.
It's like judging a city's safety by its total population. The number alone tells you nothing about what's actually going on.
The ratios I actually pay attention to now
Triglyceride/HDL ratio
This one changed how I think about the whole thing. It's arguably the most predictive ratio for cardiovascular risk — and it's also a proxy for insulin resistance, which most people don't realize.
Below 2.0 is considered optimal. Above 3.0 warrants attention. Above 5.0 is associated with significantly elevated risk.
To calculate it yourself: divide your triglycerides by your HDL.
Total Cholesterol/HDL ratio
This one accounts for the protective effect of HDL in a way the total number never could. Below 3.5 is optimal. Above 5.0 is worth a real conversation with your doctor.
LDL/HDL ratio
Same idea — it's the balance between particle types that matters, not just the count.
The thing about LDL nobody tells you
Not all LDL is the same. There are two main types:
- Large, buoyant LDL — less likely to cause problems, associated with lower risk even at higher numbers
- Small, dense LDL — more likely to penetrate arterial walls, associated with significantly higher risk
A standard lipid panel counts your LDL. It doesn't tell you which type you have. Your Triglyceride/HDL ratio is a reliable proxy — a low ratio suggests the larger, less harmful type. A high ratio suggests the smaller, denser type. This is why I find the ratio so much more useful than the LDL number by itself.
What this looks like in real life
Two people, same LDL of 160:
Triglycerides: 90
HDL: 65
Trig/HDL ratio: 1.4
Likely large buoyant LDL — favorable picture
Triglycerides: 220
HDL: 38
Trig/HDL ratio: 5.8
Likely small dense LDL — worth paying attention to
Same number. Completely different situations.
What ThriveIQ tracks
ThriveIQ tracks your triglycerides, HDL, LDL, and total cholesterol — and calculates your Triglyceride/HDL and Total Cholesterol/HDL ratios automatically when you log your lab values.
What I'd ask at my next appointment
- Can we look at my Triglyceride/HDL ratio alongside the total number?
- What is my HDL specifically — and is it in a good range?
- Would an LDL particle size test tell us anything useful?
- Is my total cholesterol elevated because of HDL, LDL, or both?
A high total cholesterol with great ratios is a very different situation from a normal total with poor ratios. The number your doctor quotes is just the beginning of the conversation.
If you're ready to start tracking your full picture, ThriveIQ was built for exactly this.
Start tracking at thriveiq.app