Your lipid panel decoded — ratios, targets, and which number actually predicts risk
| Number | Yours | Optimal | Grade |
|---|
A lipid panel hands you four numbers and no interpretation — and the interesting information often lives in the relationships: total-to-HDL ratio (the classic Framingham predictor), triglyceride-to-HDL (the metabolic-health tell), and non-HDL cholesterol (the sum of everything atherogenic). This tool computes and grades all of them against current targets, and maps which lever — diet, exercise, weight, medication — moves which line.
| Number | Target | What it is |
|---|---|---|
| LDL | <100 (<70 with existing disease/diabetes) | The particle that builds plaque — the primary treatment target |
| HDL | >40 men / >50 women; ~60 protective | Reverse transport — low is a risk marker (though raising it pharmacologically hasn't helped; it's a marker more than a lever) |
| Triglycerides | <150 | Circulating fat — the most diet-responsive line (sugar, alcohol, refined carbs) |
| Total ÷ HDL | <3.5 optimal, >5 elevated | The single best simple ratio for risk |
| Trig ÷ HDL | <2 | >3 suggests insulin resistance and small-dense LDL — worth a fasting-glucose conversation even with 'normal' LDL |
Cholesterol is one input into ten-year risk equations alongside blood pressure (see the BP tool), smoking, diabetes, age and family history — the ASCVD calculator your clinician runs. An LDL of 130 means different things at 25 with no risk factors versus 55 with hypertension. The statin conversation is a risk conversation, not a cholesterol-number conversation — bring these grades to it as literacy, not verdicts.
For treatment decisions: LDL (or non-HDL). For quick risk intuition: total÷HDL. For metabolic early-warning: trig÷HDL. The panel is a dashboard, not a single gauge — which is why this tool grades all of them.
Modern guidance: non-fasting panels are fine for most screening (LDL and HDL barely move); triglycerides rise post-meal, so a high non-fasting trig gets rechecked fasted. Follow your lab's instruction either way.
Dietary cholesterol moves blood cholesterol modestly in most people — current guidelines dropped strict egg limits. The bigger dietary levers: saturated fat (butter, fatty meat), trans fat (avoid entirely), and for triglycerides, sugar and alcohol.
Partially, in ratio terms — but LDL still deposits plaque, and drugs that raised HDL failed to prevent events. High HDL is good news, not a hall pass; the LDL target stands on its own with real risk.
Triglycerides: weeks. LDL: 5-15% in 6-12 weeks of consistent change (fiber + saturated-fat swaps). HDL: months, via exercise/weight. Recheck at 3 months — sooner just measures noise.
A CT scan counting actual arterial plaque — the tiebreaker when risk is intermediate and the statin decision is genuinely unclear. A score of zero powerfully de-escalates; high scores settle the argument the other way. Ask about it if you're on the fence.
Yes — lab values never leave your browser.
Know your ratios, watch the trend across annual panels, and treat the levers as a system — fiber, sugar, movement, and the statin conversation when the risk math says so. Heart disease is the most preventable killer we have; the dashboard is cheap.