LDL/HDL Ratio

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Lipid ratio for cardiac risk.

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LDL/HDL Ratio - Comprehensive Medical Test Information Guide

Why is it done?
- Measures the ratio between low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol to assess cardiovascular risk more comprehensively than individual cholesterol values alone
- Evaluates overall cardiovascular health and risk for developing coronary artery disease, heart attack, and stroke
- Screens for dyslipidemia and metabolic disorders in asymptomatic individuals with risk factors
- Monitors effectiveness of lipid-lowering medications (statins, fibrates) and lifestyle modifications
- Performed as part of routine health screenings, especially for adults over age 40 or those with family history of heart disease
- Identifies individuals requiring preventive interventions or lifestyle changes to reduce cardiovascular risk
Normal Range
- Optimal Ratio: Less than 3.0 (indicates lower cardiovascular risk)
- Desirable Ratio: 3.0 to 5.0 (acceptable cardiovascular risk)
- Borderline High: 5.0 to 6.5 (moderate to increased cardiovascular risk)
- High Risk: Greater than 6.5 (significantly elevated cardiovascular risk)
- Units of Measurement: Ratio (unitless number obtained by dividing LDL cholesterol value by HDL cholesterol value)
- Important Notes: Normal ranges may vary slightly between laboratories and based on individual risk factors. Normal results indicate LDL is appropriately low relative to protective HDL cholesterol. Abnormal (elevated) results suggest increased atherogenic potential and cardiovascular risk requiring intervention.
Interpretation
- Optimal Results (Ratio <3.0): Indicates excellent lipid profile with low LDL (bad cholesterol) relative to high HDL (good cholesterol). Suggests minimal cardiovascular risk and protective lipid metabolism. Patient should maintain current lifestyle and diet.
- Desirable Results (Ratio 3.0-5.0): Represents acceptable cardiovascular risk level. LDL is moderately controlled and HDL is adequate for some protection. Continue healthy lifestyle modifications and regular monitoring.
- Borderline High Results (Ratio 5.0-6.5): Indicates moderate to moderately elevated cardiovascular risk. Warrants lifestyle interventions including diet modification, increased physical activity, weight management, and stress reduction. May require medication based on individual risk factors.
- High Risk Results (Ratio >6.5): Represents significantly elevated cardiovascular risk with atherogenic lipid profile. Indicates LDL is excessively high relative to protective HDL. Usually requires pharmacological intervention with statins or other lipid-lowering agents combined with aggressive lifestyle modifications.
- Factors Affecting Results: Diet (saturated fats, trans fats, cholesterol intake), physical inactivity, obesity, smoking, alcohol consumption, genetic predisposition, hormonal status (menopause, oral contraceptives), diabetes, hypothyroidism, liver disease, kidney disease, medications (beta-blockers, corticosteroids), stress levels, and age
- Clinical Significance: The LDL/HDL ratio is a stronger predictor of cardiovascular disease risk than individual cholesterol values. A lower ratio indicates better cardiovascular protection. Higher ratios correlate with increased plaque formation in arterial walls, atherosclerosis progression, and higher probability of myocardial infarction and ischemic stroke.
Associated Organs
- Primary Organ Systems: Cardiovascular system (heart, arteries, blood vessels), hepatic system (liver - produces and metabolizes cholesterol), and endocrine system (hormonal regulation of lipid metabolism)
- Conditions Associated with Elevated Ratio: Hyperlipidemia, dyslipidemia, metabolic syndrome, type 2 diabetes, obesity, hypothyroidism, chronic kidney disease, liver cirrhosis, familial hypercholesterolemia, premature coronary artery disease
- Diseases This Test Helps Diagnose or Monitor: Coronary artery disease, atherosclerosis, myocardial infarction risk, cerebrovascular disease, peripheral arterial disease, lipid disorders, metabolic syndrome, insulin resistance, type 2 diabetes complications, and cardiovascular event risk stratification
- Potential Complications from Abnormal Results: Progressive atherosclerotic plaque accumulation in coronary arteries, carotid arteries, and cerebral vessels; acute myocardial infarction; sudden cardiac death; ischemic stroke; transient ischemic attack; peripheral arterial occlusion; limb ischemia; aortic aneurysm; and chronic heart failure from atherosclerotic cardiomyopathy
- Organ-Specific Impact: Heart (coronary atherosclerosis, myocardial ischemia), brain (cerebral atherosclerosis, stroke risk), kidneys (glomerulosclerosis, renal dysfunction), extremities (claudication, tissue necrosis), and endothelium (dysfunction, inflammation)
Follow-up Tests
- Recommended When Results Are Elevated: Complete lipid panel (total cholesterol, LDL, HDL, triglycerides), lipoprotein(a) [Lp(a)], apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1), and small dense LDL particle testing
- Diagnostic Cardiovascular Tests: Electrocardiography (ECG), echocardiography, exercise stress testing, cardiac computed tomography (CT) angiography, coronary catheterization, carotid intima-media thickness (CIMT) ultrasound, and ankle-brachial index (ABI)
- Metabolic and Endocrine Tests: Fasting glucose, hemoglobin A1c (HbA1c), thyroid-stimulating hormone (TSH), free T4, liver function tests, renal function tests (creatinine, glomerular filtration rate)
- Inflammatory Markers: High-sensitivity C-reactive protein (hs-CRP), fibrinogen, and other inflammatory biomarkers to assess vascular inflammation risk
- Monitoring Frequency: Optimal/desirable results: recheck every 5 years for general population; annually for high-risk individuals. Borderline/elevated results: recheck every 6-12 months. After medication initiation: recheck at 4-12 weeks, then every 6-12 months. During therapy adjustment: more frequent monitoring as directed by physician.
- Complementary Assessments: Framingham Risk Score calculation, ASCVD risk assessment, 10-year cardiovascular event prediction, body mass index (BMI) calculation, blood pressure monitoring, and cardiovascular risk stratification
Fasting Required?
- Fasting Requirement: Yes - Fasting is required for accurate lipid panel results
- Duration and Instructions: Fast for 9-12 hours prior to blood draw. Begin fasting after dinner the evening before the test. Only water is permitted during fasting period. Blood collection should occur in the morning after overnight fast.
- Medications to Avoid or Adjust: Do not discontinue lipid-lowering medications (statins, fibrates, niacin) unless specifically instructed by physician - continue taking regularly scheduled medications. Avoid taking new medications the morning of the test without discussing with healthcare provider. Some medications affect lipid metabolism; inform laboratory of current medication list.
- Additional Patient Preparation: Maintain stable diet for 2 weeks prior to testing (avoid sudden dietary changes). Continue normal exercise routine. Avoid alcohol for 24 hours before blood draw. Avoid strenuous exercise the day of testing. Remain seated for 5 minutes before blood collection. Maintain relaxed state to minimize stress-related lipid elevation.
- Special Considerations: Non-fasting lipid panels may underestimate triglycerides and affect ratio calculation accuracy. Women should avoid testing during menstrual cycle if possible due to hormonal effects. Recent illness or significant life stress may temporarily elevate cholesterol values. Repeat testing recommended if results are inconsistent with clinical presentation or previous values.

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