How to work out your triglycerides to HDL cholesterol ratio

Get to know your triglycerides to HDL (TG:HDL) cholesterol ratio for insights into your metabolic and heart disease risk.

lizzie-lynch

Author: Lizzie Lynch - Content Lead, BA(Hons)

Reviewed by: Dr Natasha Fernando Medical Director, MBBS, MRCGP

Published on: 02 February 2024

Did you know that even if you are managing your low-density lipoprotein (LDL) cholesterol with statins or lifestyle changes, you can still be at risk of heart disease? 

There are other ways you can assess your heart disease risk, such as your TG:HDL ratio, which takes into account your balance of triglycerides and good cholesterol. 

If you've recently had a lipid or cholesterol test, we'll dive into this all-important ratio for your heart health. 

What causes high levels of triglycerides?


Triglycerides are a type of fat in your blood – also known as a lipid. Your body stores excess calories as triglycerides that can be broken down to release energy when the body needs it. 

High levels of triglycerides are usually present in overweight or obese people, but not always. 

You're more likely to have elevated levels if you:  

  • Are overweight or obese 
  • Drink excessive amounts of alcohol 
  • Have hypothyroidism (an underactive thyroid) 
  • Have raised LDL (bad) cholesterol 
  • Have poorly controlled diabetes 
  • Lead a sedentary lifestyle 
  • Nephrotic (a type of kidney condition) 

You may have chronically high levels of triglycerides if you regularly eat more calories than your body uses. A common cause for acute high triglyceride levels is eating too close to taking your blood test. In this case, your body may simply be still processing the calories you've just consumed. Retaking the test and avoiding high-fat meals beforehand can help to produce a more reliable result. 

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What is a normal triglyceride level in the UK? 


A healthy result for a non-fasting triglyceride level is below 2.3 mmol/L. If you fast for your test, then your healthy result should be less than 1.7mmol/L [1]. 

HDL cholesterol 

HDL cholesterol is your good cholesterol. It transports excess cholesterol from your bloodstream to your liver. Your liver then removes the excess cholesterol through bile. This helps prevent cholesterol from building up in your arteries.  

HDL vs LDL 

LDL cholesterol can cause fatty deposits to build up in your arteries. HDL cholesterol keeps those deposits moving and helps remove them from the bloodstream. Too much LDL can be harmful whereas HDL is beneficial.  

 

Why is TG:HDL important?


The TG:HDL ratio is more valuable to some aspects of your health than knowing single fat biomarkers alone. It has been more significantly associated with health outcomes than any other individual lipid parameters and ratios [2]. 

This lipid ratio reflects the complex interaction between how your body processes lipoproteins and may give more insights into your risk of artery narrowing [3]. This doesn't just apply to heart disease, either. Some studies have also found that TG:HDL is a better indicator for metabolic syndrome than total cholesterol to HDL (TC:HDL) and LDL:HDL ratios [4]. 

Three health risks of high TG:HDL

1. Heart disease  

Your TG:HDL ratio is strongly associated with heart disease risk. People with a higher TG:HDL ratio are more likely to have high-risk plaques and narrowing arteries [5]. 

If you already have a high risk for heart disease, your TG:HDL ratio might give a better indication of your immediate risk. This is true even if your LDL levels are normal. 

2. Metabolic syndrome 

A study of 1,267 adults found that TG:HDL was a risk factor for metabolic syndrome. This held even when taking into account other factors such as blood pressure, blood glucose, age, sex, and BMI. [6] 

Based on this, many studies have described TG:HDL as a better indicator of metabolic syndrome than other ratios, such as: 

  • Non-HDL:HDL 
  • TC:HDL 
  • LDL:HDL  

3. Insulin resistance and diabetes 

The TG:HDL ratio performs similarly to the metabolic score. It can identify people who struggle with insulin and have a higher risk of developing heart issues, even if they appear healthy. 

Studies show that women are at a significantly increased risk of developing insulin resistance and prediabetes if their TG:HDL is above three. This also applies to women with a healthy weight. [7]  

 

How to work out your TG:HDL


To find your ratio, divide your triglyceride level by your HDL cholesterol level in your blood test results. Make sure your results use the same units (usually mmol/L). 

 

Normal TG:HDL levels


There are no widely accepted normal values for the TG:HDL ratio. Generally, the lower your result the better.  

Studies have explored how TG:HDL ratio is linked to health risks. Ideally, it's best to aim for a TG:HDL ratio of less than 0.87. A result of two or more is linked to a significantly higher risk of metabolic syndrome and heart disease. 

 

How to improve your TG:HDL result


Improving your TG:HDL ratio means working on lowering your triglycerides and increasing your HDL cholesterol.  

Five ways to lower triglycerides: 

  1. Drink in moderation 
  2. Lose weight if you're overweight 
  3. Move more and regularly exercise 
  4. Say no to saturated fats and added sugars 
  5. Stop smoking 

Most of these changes will also likely improve your HDL level. Eating certain foods and choosing unsaturated fats over saturated fats may also boost your good cholesterol.  

Five foods to increase your HDL cholesterol 

  1. Beans and legumes 
  2. Nuts and seeds 
  3. Olive oil 
  4. Oily fish 
  5. Whole grains 

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For more advice, visit our blogs on total cholesterol and the Mediterranean diet.  

 

How reliable is TG:HDL? 


TG:HDL ratios vary according to ethnicity. Black people tend to have lower TG:HDL ratios compared to other ethnic groups and therefore cut-offs may be less applicable. [8] 

Your result may be skewed if you take lipid-lowering medication (like fibrates or niacin). Even with a low TG:HDL result, you could still be at risk of developing diabetes or heart disease. [9] 

  

Is TG:HDL a good measure for long-term health?


Heart disease remains one of the leading causes of death worldwide. And years before developing diabetes, people with insulin resistance could be more at risk of unfavourable health outcomes. These conditions affect how long you live and how long you live in good health.  

Knowing your TG:HDL can help you identify your risk of heart disease and insulin resistance, even if you are otherwise healthy. It is likely to be a better predictor of your heart disease at metabolic risk than individual lipid markers and ratios like TC:HDL and LDL:LDL. 

That said, interpreting your TG:HDL results with other risk factors (like whether you are overweight, have high blood pressure, or raised blood glucose levels) is vital. Many factors contribute to cardiometabolic risk and TG:HDL is just one of them. 

 

What is the blood test for TG:HDL?


You can check your cholesterol and triglyceride levels with a simple lipid profile blood test.  

Our Optimal Health Blood Test offers a fuller picture of your risk of heart disease and diabetes. It includes information on your TG:HDL ratio and other biomarkers that are linked to longevity, such as an apolipoprotein profile.  

“Optimal

 

References 

  1. Heart UK. (n.d.). Triglycerides. [Online] Available at: Heart UK. (n.d.). Triglycerides. [Online] Available at: https://www.heartuk.org.uk/cholesterol/triglycerides
  2. Singh, S. K., Aggarwal, J., Kathariya, G., & Manzoor, S. (2020). Usefulness of the TG/HDL Ratio in Predicting Cardiovascular Risk: A MMIMSR Experience. [Online] Available at: Singh, S. K., Aggarwal, J., Kathariya, G., & Manzoor, S. (2020). Usefulness of the TG/HDL Ratio in Predicting Cardiovascular Risk: A MMIMSR Experience. [Online] Available at: https://imsear.searo.who.int/handle/123456789/211015
  3. Liao, L. P., Wu, L., & Yang, Y. (2023). The relationship between triglyceride/high-density lipoprotein cholesterol ratio and coronary microvascular disease. BMC Cardiovascular Disorders, 23, 228. doi:10.1186/s12872-023-03229-4
  4. Abbasian, M., Delvarianzadeh, M., Ebrahimi, H., & Khosravi, F. (2017). Lipid ratio as a suitable tool to identify individuals with MetS risk: A case-control study. Diabetes Metab Syndr, 11(Suppl 1), S15–S19. doi:10.1016/j.dsx.2016.08.011
  5. Miki, T., Miyoshi, T., Suruga, K., Ichikawa, K., Otsuka, H., Toda, H., et al. (2020). Triglyceride to HDL-cholesterol ratio is a predictor of future coronary events: a possible role of high-risk coronary plaques detected by coronary CT angiography. European Heart Journal, 41, ehaa946.2930. doi:10.1093/ehjci/ehaa946.2930
  6. Nie, G., Hou, S., Zhang, M., & Peng, W. (2021). High TG/HDL ratio suggests a higher risk of metabolic syndrome among an elderly Chinese population: a cross-sectional study. BMJ Open, 11, e041519. doi:10.1136/bmjopen-2020-041519
  7. Borrayo, G., Basurto, L., González-Escudero, E., Diaz, A., Vázquez, A., Sánchez, L., et al. (2018). TG/HDL-C RATIO AS CARDIO-METABOLIC BIOMARKER EVEN IN NORMAL WEIGHT WOMEN. Acta Endocrinologica (Bucharest), 14, 261. doi:10.4183/aeb.2018.261
  8. Lelis, D. de F., Calzavara, J. V. S., Santos, R. D., Sposito, A. C., Griep, R. H., Barreto, S. M., et al. (2021). Reference values for the triglyceride to high-density lipoprotein ratio and its association with cardiometabolic diseases in a mixed adult population: The ELSA-Brasil study. J Clin Lipidol, 15, 699–711. doi:10.1016/j.jacl.2021.07.005
  9. Armato, J., Reaven, G., & Ruby, R. (2015). TRIGLYCERIDE/HIGH-DENSITY LIPOPROTEIN CHOLESTEROL CONCENTRATION RATIO IDENTIFIES ACCENTUATED CARDIOMETABOLIC RISK. Endocr Pract, 21, 495–500. doi:10.4158/EP14479.OR
  10. Rezapour, M., Shahesmaeili, A., Hossinzadeh, A., Zahedi, R., Najafipour, H., & Gozashti, M. H. (2018). Comparison of Lipid Ratios to Identify Metabolic Syndrome. Arch Iran Med, 21, 572–577.