Your TG:HDL ratio is calculated on a fasting lipid profile. A calculator is here: Simply take the Triglyceride and divide by the HDL; the closer to one, the better. For example: TG = 120 mg/dL and HDL=40 mg/dL. 120 / 40 = 3.0, and indicates an elevated risk of heart attack and stroke. In fact, at 3:1 the likelihood of a heart attach goes way up!

Low TG:HDL is desirable. As long as the TG is not below 40, your ratio can be below 1:1, as it is in many well-trained and properly nourished athletes, for example a TG of 50 mg/dL and HDL of 80 mg/dL provides a low TG:HDL ratio of 0.6.

High TG:HDL, especially >3, indicates significant risk of heart attack and stroke. I realize that high cholesterol, especially LDL, gets most of the press, and this is do primarily to the interest in pharmaceutical industry interests hard-selling the cholesterol story. The research and relevance about the TG:HDL ratio is detailed further below if you like reading about research.

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Your Triglyceride/HDL ratio helps offer a lifelong metric for your health.

TG:HDL is one of the criteria for the diagnosis of metabolic syndrome, which was briefly known as Reaven’s syndrome, named after Gerald Reaven, MD, of Stanford University. He and his colleagues around the world pioneered much of the research on TG:HDL ratio that indicates cardiovascular risk.^[i] TG:HDL is a strong marker of lifestyle factors—Your TG:HDL ratio offers a way to see whether you have a metabolism that naturally has cardiac protection (the lucky ones), or whether you need to earn it (like me). Let me explain the studies.

Three thousand people were categorized for known risk factors for heart attack and stroke: smoking, high blood pressure, or a sedentary lifestyle. In all of the categories, those with the higher TG:HDL ratios (>3) had the highest incidence of heart attacks and strokes, compared to those with the lowest ratio (<1.1), and the incidence of events was linear with the TG:HDL ratio.

In fact, the group that had the lower ratio and smoked cigarettes had no more cardiac events than nonsmokers. This particular finding entertained journalists, who concluded that “You can smoke if you have a low TG:HDL ratio.” Remember, this study only looked at cardiovascular disease, not cancer, so I still advise restraint. Know your TG:HDL ratio, and keep yourself in the lower range, as close to 1 as possible.^[ii]

Triglyceride is not an adequate test on its own. As TG goes up, the fat and sugar is stored in the liver, making it less able to function properly. Therefore, the liver does not produce the healthful HDL. The medical journals refer to this condition as diabetic atherogenic dyslipidemia. Intimidating name, but as it implies, when these lipids get out of balance, atherosclerosis and heart disease follow; and likewise, your disease risk goes down with improvement in your TG:HDL.

[i] Reaven, M. D., Gerald, T. K., Fox, B. Syndrome X: The Silent Killer; The New Heart Disease Risk. Simon & Schuster, 2001.

[ii] Jeppesen, J., et al. Low triglycerides-high high-density lipoprotein cholesterol and risk of ischemic heart disease. Arch Intern Med. 2001; 161:361–66.