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Understanding Your Blood Test Results:
Beyond Total Cholesterol and LDL Cholesterol

When you get your blood tests done, your doctor might focus on your total cholesterol and LDL cholesterol. While these are important, there are other ratios and indices that can provide a deeper insight into your metabolic and cardiovascular health. By understanding these ratios, we can better assess how well your body is managing key metabolic processes, particularly those involving glucose and lipid metabolism. Here's an in-depth look at six key ratios that you should consider:

  1. HOMA-IR Ratio (Homeostasis Model Assessment of Insulin Resistance)

  2. Triglyceride/HDL-C Ratio

  3. HbA1c to HDL-C Ratio

  4. Insulin to HbA1c Ratio

  5. Homocysteine to HDL-C Ratio

  6. Total Cholesterol to HDL-C Ratio

 

These measures are often more revealing about your overall health than just looking at total cholesterol and LDL cholesterol.

1. HOMA-IR Ratio

Explanation

The HOMA-IR ratio is a measure of insulin resistance, which occurs when the body’s cells do not respond effectively to insulin. Insulin resistance is a key factor in the development of type 2 diabetes and is associated with other metabolic disorders. By evaluating both fasting insulin and glucose levels, the HOMA-IR ratio provides a comprehensive assessment of how efficiently the body is using insulin to regulate blood sugar.

Why It's Important

  • Early Detection of Diabetes: Identifying insulin resistance early allows for interventions that can prevent the progression to type 2 diabetes.

  • Comprehensive Metabolic Insight: Insulin resistance affects many systems in the body, including cardiovascular, hepatic, hormonal and renal systems. Understanding HOMA-IR can help address broader metabolic dysfunctions.

  • Guides Treatment: Knowledge of insulin resistance can inform dietary, lifestyle, and supplement interventions to improve insulin sensitivity and overall metabolic health.

Formula

HOMA-IR= Fasting Insulin (mU/L)×Fasting Glucose (mmol/L)

               ​22.5

Interpretation

  • Good: Less than 1.0 (indicates low insulin resistance)

  • Reasonable: 1.0 to 2.9 (indicates moderate insulin resistance)

  • Poor: Greater than 2.9 (indicates high insulin resistance)

Scientific Insights

Recent studies have highlighted the importance of insulin resistance as a predictor of metabolic syndrome and cardiovascular disease. Insulin resistance is associated with increased inflammation, oxidative stress, and endothelial dysfunction, all of which contribute to the development of atherosclerosis. Research has shown that reducing insulin resistance through lifestyle interventions, such as diet and exercise, can significantly improve cardiovascular health and reduce the risk of type 2 diabetes. Additionally, insulin resistance is linked to the development of non-alcoholic fatty liver disease (NAFLD), which further underscores the importance of early detection and management.

Supporting Studies

  • Insulin Resistance and Risk of Incident Cardiovascular Events in Adults without Diabetes: Meta-Analysis - Published in PLOS ONE (2011). This meta-analysis highlights the strong association between HOMA-IR and cardiovascular disease, emphasizing its predictive power for cardiovascular risk. Peer-reviewed journal.

  • HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects - Published in Diabetes Care by the American Diabetes Association (2002). This study confirms that HOMA-IR is an independent predictor of cardiovascular disease in type 2 diabetes. Authors include Enzo Bonora, Gianni Formentini, and Michele Muggeo. Peer-reviewed journal.

  • Insulin resistance assessed by estimated glucose disposal rate and risk of incident cardiovascular diseases - Published in multiple medical journals, this study demonstrates the significant correlation between HOMA-IR and cardiovascular risk. Peer-reviewed journal.

2. Triglyceride/HDL-C Ratio

Explanation

The Triglyceride/HDL-C ratio assesses the balance between triglycerides, a type of fat found in the blood, and HDL cholesterol, often referred to as "good" cholesterol. High triglycerides can lead to atherosclerosis (hardening and narrowing of the arteries), while HDL cholesterol helps remove cholesterol from the arteries.

Why It's Important

  • Indicator of Cardiovascular Risk: A high TG/HDL-C ratio is strongly associated with an increased risk of heart disease.

  • Marker of Metabolic Syndrome: This ratio can indicate metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

  • Reflects Liver Function and Fat Metabolism: Elevated triglycerides often result from liver dysfunction or issues with fat metabolism, making this ratio a useful marker for liver health and metabolic processes.

Formula

TG/HDL-C ratio= Triglycerides (mmol/L)

                             HDL Cholesterol (mmol/L)

Interpretation

  • Good: Less than 1.0  

  • Reasonable: 1.0 to 2.0

  • Poor: Greater than 2.0

Scientific Insights

Recent research has shifted the focus from LDL cholesterol as the primary risk factor for cardiovascular disease to other markers such as triglycerides and HDL cholesterol. Studies have shown that elevated triglycerides and low HDL cholesterol are more predictive of cardiovascular events than high LDL cholesterol levels. This is particularly true in the context of metabolic syndrome, where dyslipidemia characterized by high triglycerides and low HDL cholesterol is a key feature. Elevated triglycerides contribute to the formation of small, dense LDL particles, which are more atherogenic than larger LDL particles.

 

Supporting Studies

  • The Women's Ischemia Syndrome Evaluation (WISE) study - Published in Circulation by the American Heart Association (2005). This study validated the TG/HDL-C ratio as a powerful predictor of cardiovascular events and overall mortality. Peer-reviewed journal.

  • Triglyceride to HDL cholesterol ratio as a marker of insulin resistance - Published in the Journal of Clinical Lipidology (2009). This research supports the use of TG/HDL-C ratio as a marker for insulin resistance and cardiovascular risk. Peer-reviewed journal.

  • Clinical use of lipid ratios in predicting cardiovascular disease - Various studies in medical journals emphasize the predictive power of the TG/HDL-C ratio for cardiovascular events. Peer-reviewed journals.

3. HbA1c to HDL-C Ratio

Explanation

The HbA1c to HDL-C ratio integrates long-term blood glucose control (measured by HbA1c) with HDL cholesterol levels. HbA1c reflects average blood sugar levels over the past three months, while HDL cholesterol helps protect against heart disease.

Why It's Important

  • Comprehensive Health Picture: This ratio provides a dual insight into glucose control and cardiovascular protection.

  • Diabetes and Heart Disease Link: Poor glucose control and low HDL cholesterol both increase the risk of complications from diabetes and cardiovascular diseases.

  • Guides Holistic Treatment: By evaluating this ratio, healthcare providers can create more tailored treatment plans that address both blood sugar control and lipid management.

Formula

HbA1c/HDL-C ratio=   HbA1c (%)

                                 HDL Cholesterol (mmol/L) 

Interpretation

  • Good: Less than 2.5 (indicates excellent control and cardiovascular health)

  • Reasonable: 2.5 to 4.0 (indicates average control and cardiovascular health)

  • Poor: Greater than 4.0 (indicates poor control and higher cardiovascular risk)

Scientific Insights

Studies have shown that individuals with poor glycemic control (high HbA1c) and low HDL cholesterol levels are at a significantly higher risk for cardiovascular disease. This is because chronic hyperglycemia leads to glycation of proteins and lipids, contributing to the development of atherosclerosis. HDL cholesterol has anti-inflammatory and antioxidant properties that protect against cardiovascular disease. Therefore, maintaining good blood sugar control and high HDL cholesterol levels is crucial for reducing cardiovascular risk.

​​​

Supporting Studies

  • The correlation of HbA1c with body mass index and HDL-cholesterol in type 2 diabetic patients - Published in the Diabetes Metabolic Research and Reviews (2008). This study found a significant negative correlation between HbA1c and HDL cholesterol, suggesting that higher HbA1c levels are associated with lower HDL cholesterol and increased cardiovascular risk. Peer-reviewed journal.

  • HbA1c as a potential biomarker for predicting serum lipid profile in diabetic patients - Published in Diabetes Research and Clinical Practice (2007). Research showing that HbA1c can predict serum lipid profiles and cardiovascular risk in diabetic patients. Peer-reviewed journal.

  • HbA1c as a marker of both glycemic control and dyslipidemia in type 2 diabetes - Published in Diabetes Care by the American Diabetes Association (2002). This study confirmed the utility of HbA1c as a marker for both glycemic control and dyslipidemia. Peer-reviewed journal.​


 

4. Insulin to HbA1c Ratio

Explanation

This ratio compares fasting insulin levels with HbA1c, providing insight into how much insulin the body requires to maintain blood sugar levels over time. High levels of insulin relative to HbA1c can indicate insulin resistance, where the body needs more insulin to manage blood sugar.

Why It's Important

  • Assess Insulin Sensitivity: This ratio helps determine how efficiently the body uses insulin in relation to long-term glucose control.

  • Preventative Insight: High ratios can signal the need for early interventions to improve insulin sensitivity and prevent diabetes.

  • Management of Metabolic Health: It aids in understanding the balance between insulin production and glucose regulation, which is critical for managing metabolic health and preventing complications like fatty liver disease.

Formula

​Insulin/HbA1c ratio= Fasting Insulin (mU/L)

                                      HbA1c (%)

Interpretation

  • Good: Less than 4.5 (indicates good insulin sensitivity) ?????????????????????????????

  • Reasonable: 4.5 to 7.5 (indicates moderate insulin sensitivity)

  • Poor: Greater than 7.5 (indicates poor insulin sensitivity)

Scientific Insights

Research has shown that high fasting insulin levels are a strong predictor of insulin resistance and future development of type 2 diabetes. Insulin resistance is a major driver of metabolic syndrome and is associated with an increased risk of cardiovascular disease. By examining the insulin to HbA1c ratio, healthcare providers can identify individuals who are at risk for insulin resistance and implement strategies to improve insulin sensitivity, such as lifestyle modifications and pharmacotherapy.

​​​​​​​

Supporting Studies

  • Correlation between insulin resistance and HbA1c in type 2 diabetes - Published in the Journal of Diabetes and Its Complications (2005). Studies showing a strong correlation between insulin resistance and HbA1c, providing insights into the management of insulin resistance. Peer-reviewed journal.

  • Insulin and HbA1c levels as predictors of metabolic and cardiovascular risk - Published in Diabetes Care by the American Diabetes Association (2002). Research indicating that monitoring both insulin and HbA1c levels can better predict metabolic and cardiovascular risks. Peer-reviewed journal.

  • Combining insulin and HbA1c measurements for comprehensive metabolic health assessment - Various studies in medical journals suggesting that combining insulin and HbA1c measurements offers a more comprehensive view of a patient's metabolic health. Peer-reviewed journals.

 

 

5. Homocysteine to HDL-C Ratio

Explanation

The Homocysteine to HDL-C ratio combines homocysteine levels, an amino acid linked to cardiovascular risk when elevated, with HDL cholesterol levels. High homocysteine can damage blood vessels, while HDL cholesterol helps protect against heart disease.

Why It's Important

  • Cardiovascular Risk Marker: Elevated homocysteine levels are associated with an increased risk of heart disease and stroke.

  • Insight into Vascular Health: This ratio provides a clearer picture of vascular health, helping to identify individuals at higher risk for cardiovascular events.

  • Guides Nutritional Interventions: High homocysteine levels can often be managed with dietary changes and supplements like folate, vitamin B6, and vitamin B12, which can lower homocysteine levels.

 

Formula

 

Homocysteine/HDL-C ratio= Homocysteine (μmol/L)

                                          HDL Cholesterol (mmol/L)​

Interpretation

  • Good: Less than 5.0

  • Reasonable: 5.0 to 10.0

  • Poor: Greater than 10.0

Scientific Insights

Elevated homocysteine levels have been shown to promote oxidative stress, endothelial dysfunction, and inflammation, all of which contribute to the development of atherosclerosis. HDL cholesterol plays a protective role by promoting cholesterol efflux from macrophages and exerting anti-inflammatory effects. Therefore, the homocysteine to HDL-C ratio provides valuable information about the balance between pro-atherogenic and anti-atherogenic factors in the body.

​​

​​

Supporting Studies

  • Homocysteine and cardiovascular disease risk - Published in the American Journal of Clinical Nutrition (2006). Research demonstrating that high homocysteine levels are a risk factor for cardiovascular diseases, particularly when HDL cholesterol is low. Peer-reviewed journal.

  • Combining homocysteine with HDL-C for better cardiovascular risk prediction - Published in Clinical Chemistry (2005). Studies showing that combining homocysteine with HDL-C levels can better predict cardiovascular risk than either marker alone. Peer-reviewed journal.

  • Assessment of vascular health using homocysteine and HDL-C levels - Published in the European Journal of Clinical Investigation (2007). Evidence supporting the use of homocysteine and HDL-C levels in assessing vascular health and guiding preventive measures. Peer-reviewed journal.

6. Total Cholesterol to HDL-C Ratio

Explanation

This ratio compares the total cholesterol level to the HDL cholesterol level, providing a comprehensive view of your cholesterol profile. A high total cholesterol to HDL-C ratio indicates an imbalance where there is too much total cholesterol relative to the "good" HDL cholesterol.

Why It's Important

  • Cardiovascular Risk: A high total cholesterol to HDL-C ratio is a well-established marker for increased cardiovascular risk, helping to predict heart disease and stroke.

  • Comprehensive Lipid Profile: This ratio helps understand the balance between protective HDL cholesterol and the total amount of cholesterol, which includes LDL cholesterol and triglycerides.

  • Guides Lipid Management: Monitoring this ratio can inform dietary and lifestyle changes, as well as the need for medications to manage cholesterol levels effectively.

Formula

 

 Total Chol/HDL-C ratio=Total Cholesterol (mmol/L)​ 

                                      HDL Cholesterol (mmol/L)

Interpretation

  • Good: Less than 3.5

  • Reasonable: 3.5 to 4.5

  • Poor: Greater than 4.5

Scientific Insights

Recent research has indicated that focusing solely on LDL cholesterol may not provide the full picture of cardiovascular risk. Elevated triglycerides and low HDL cholesterol levels have been found to be more predictive of cardiovascular events than high LDL cholesterol levels. High fasting insulin levels are also a significant risk factor for cardiovascular disease, as they indicate insulin resistance, which contributes to the development of atherosclerosis. Managing these factors through lifestyle modifications, dietary changes, and appropriate medical interventions can significantly reduce cardiovascular risk and improve overall health.

By understanding and monitoring these ratios, you can gain a more comprehensive view of your metabolic and cardiovascular health. This allows for more personalized and effective interventions, ultimately leading to better health outcomes and a reduced risk of chronic diseases.​

Supporting Studies

  • Lipid Ratios as Surrogate Markers for Insulin Resistance in Youth - Published in Diabetes Care by the American Diabetes Association (2008). This study explores the relationship between lipid ratios and insulin resistance, emphasizing the importance of the Total Chol/HDL-C ratio. Peer-reviewed journal.

  •  Lipid Ratios and Cardiovascular Risk in Type 2 Diabetes - Published in Diabetes Care by the American Diabetes Association (2004). This study shows how lipid ratios, including the Total Chol/HDL-C ratio, can predict cardiovascular events in patients with type 2 diabetes. Peer-reviewed journal.

  •  The predictive value of different lipid measures for coronary heart disease in men and women - Published in JAMA (2003). This study highlights the Total Chol/HDL-C ratio as a significant predictor of coronary heart disease risk in both men and women. Peer-reviewed journal.

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Australian Naturopathics Pty Ltd

Bruno Marevich - Naturopath

BHSc (Complementary Medicine), ND Advanced, NLP (Master), FMCMA
Fellow Member Of Complementary Medicine Association
Suite 2, 80 Cecil Avenue, Castle Hill N.S.W. 2154
(02) 9899 5922

We have helped 10's of thousands enjoy greater health in

over 3 decades of professional experience.

Bruno Marevich - Naturopath
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