Summary

The Cholesterol to High-Density Lipoprotein (Chol/HDL) index, also known as the atherogenic index, is an important indicator of heart health. High levels of the Chol/HDL index suggest an increased risk of developing heart disease, as it means that there is a higher proportion of total cholesterol to "good" cholesterol, which is HDL. Low levels of the Chol/HDL index are generally healthier, indicating a lesser risk of heart disease.

‍

Overview

This index is calculated by dividing the total cholesterol by the high-density lipoprotein (HDL) level, often known as the "good" cholesterol. 

A high Chol/HDL index indicates a higher proportion of total cholesterol to HDL, typically associated with an increased risk of heart disease. This could be due to conditions like metabolic syndrome, diabetes, or obesity, which are known to affect cholesterol levels negatively. Regular monitoring and appropriate management of cholesterol levels are critical in preventing heart disease.

A low Chol/HDL index is generally considered healthy and suggests a lower risk of developing heart disease. It means there is more "good" cholesterol that can remove "bad" cholesterol (LDL) from your bloodstream, thus helping to prevent the buildup of plaque in your arteries.^[1-3]

‍

What should you know about this biomarker?

Reference ranges often vary between laboratories because they use different approaches to calculate the result.^[4,5]

The optimal Chol/HDL index is usually reported as less than 5. 

For those at risk, keeping the index below 4 is recommended, while prognostically favorable results are associated with a value below 3.5. 

In Macromo, we use the equation written below for the calculation of the result: 

Total Cholesterol  HDL Cholesterol = Chol/HDL index

‍

Here are examples of the calculation:

Your total cholesterol level = 6 mmol/l

Your HDL cholesterol level = 1 mmol/l

6 ÷ 1 = 6

Your Chol/HDL index = 6  Thus an elevated risk of developing cardiovascular conditions.

‍

Your total cholesterol level = 3 mmol/l

Your HDL cholesterol level = 1.5 mmol/l

3 ÷ 1.5 =2

Your Chol/HDL index = 2  Meaning that your risk of developing cardiovascular conditions is low.

‍

Your blood test could indicate one of several potential outcomes.

• Your Chol/HDL index is low, indicating a favorable balance between cholesterol and HDL (good) cholesterol levels. This suggests a lower risk of cardiovascular disease. 
• Your Chol/HDL index falls within the average range. This indicates a moderate balance between cholesterol and HDL (good) cholesterol levels.
• Your Chol/HDL index is above the normal range, indicating an imbalance between cholesterol and HDL (good) cholesterol levels. This suggests a higher risk of cardiovascular disease.

‍

Genetics

Genetics plays a crucial role in developing conditions such as obesity, overeating, and diabetes, which in turn contribute to increased cholesterol levels.

A genetic disorder called familial hypercholesterolemia (FH) is a direct cause of high cholesterol. FH leads to a noticeable spike in LDL cholesterol levels, resulting in the early development of heart disease, often affecting individuals at a young age. 

The genetic basis of FH lies in modifications in the LDL receptor gene (LDLR). This gene encodes a protein that removes LDL cholesterol from our bloodstream. When this gene is affected, it is unable to perform its task efficiently, thereby causing an increase in LDL cholesterol levels.^[6]

The heritability of HDL cholesterol is estimated to be about 62–77%. Certain individuals can have low HDL cholesterol due to genetic factors, such as Tangier disease (mutation in ABCA1 gene) or familial hypoalphalipoproteinemia.^[7,8]

‍

Recommendations

If the Chol/HDL index is higher than optimal, it is important to consider the following recommendations.^[9]:

• Choose a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and good fats. Minimize your intake of sugar, salt, and unhealthy fats, and focus on fiber-filled foods that offer plenty of vitamins and antioxidants.
• Regular exercise aids in weight loss, boosts metabolism, and reduces body inflammation. It is also a powerful tool to maintain your overall health.
• Adhere to any prescribed medication and ensure you have regular health check-ups. These routine medical visits serve as a preventive measure to safeguard your health.
• Actively manage stress levels because uncontrolled stress can negatively impact your body's defense mechanisms.
• If you're a smoker, quitting will not only improve your overall health but also increase HDL cholesterol, which aids in the removal of LDL cholesterol from your vessels.

‍

The information and tests provided on our website are for educational purposes only and are not a substitute for professional medical advice. Always consult with your healthcare provider before making health decisions. Our tests do not diagnose or treat diseases. Individual results may vary and should be discussed with a healthcare provider.