How do I calculate my triglycerides/HDL ratio?

Divide triglycerides by HDL, both in mg/dL. For example, TG of 90 and HDL of 60 gives a ratio of 1.5. If your lab reports in mmol/L (UK, Canada, Australia), multiply the ratio by 2.3 to compare against US thresholds.

What does a high triglycerides/HDL ratio mean?

A high ratio (above 3) is one of the clearest signs of insulin resistance, small dense LDL, and metabolic syndrome. It often appears years before fasting glucose or A1c become abnormal. The lifestyle levers that move it most are cutting refined carbs and sugar, regular exercise, and weight loss. Treating insulin resistance brings TG down and HDL up at the same time.

What is a normal triglycerides/HDL ratio?

Below 2.0 (using mg/dL) is optimal. Above 3 strongly suggests insulin resistance, small dense LDL particles, and metabolic syndrome, even when individual lipid numbers look acceptable. In mmol/L (UK, Canada, Australia), multiply your ratio by 2.3 to compare against US thresholds.

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Triglycerides/HDL Ratio

Normal range: 0 – 2 (lower is better)

The TG/HDL ratio is a practical marker of insulin resistance and small, dense LDL particle predominance. Values above 2.0 suggest increased metabolic and cardiovascular risk. It is one of the most actionable lipid ratios because both components respond dramatically to lifestyle changes. Some researchers consider it a better proxy for insulin resistance than fasting glucose.

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How much does a TG/HDL test cost?

TG/HDL is calculated rather than ordered on its own, so it comes with a standard lipid panel (about $45). A fuller workup adds Vitamin D ($75), hs-CRP ($69), ApoB ($50), and ApoA1 ($50). You can test TG/HDL and 100 other biomarkers for $190 as part of an Empirical membership.

Empirical is FSA/HSA eligible, so you can pay with pre-tax dollars. Fast for 8-12 hours beforehand for the most accurate lipid and metabolic results, and expect results in days rather than weeks.

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What can cause high TG/HDL?

A normal TG/HDL is 0 – 2. Lower is better.

A high TG/HDL ratio is the hallmark of insulin resistance and metabolic syndrome. Excess sugar, refined carbs, and alcohol raise triglycerides while inactivity and obesity lower HDL. This ratio is highly responsive to lifestyle changes: cutting sugar, reducing alcohol, exercising regularly, and losing excess weight can improve it significantly within weeks.

Because both sides of the ratio respond to the same interventions, improvements can be dramatic. A person who starts exercising and cuts sugar may see their triglycerides drop and HDL rise simultaneously, producing a much larger ratio improvement than either change alone.

Biomarkers related to TG/HDL

TG/HDL is most highly correlated with Estimated VLDL and Triglycerides. Here are the top biomarkers correlated with TG/HDL, based on 500,000 tests done by Empirical Health.

The percentage shows how strongly two biomarkers move together. A higher number means the relationship is stronger. Green = rises and falls together. Orange = one rises as the other falls.

Frequently asked questions about TG/HDL

Where to get a TG/HDL test near you

TG/HDL is drawn at 2,200+ Quest and BioReference patient service centers across the US, so there's usually one within a short drive. Browse the full directory to find the one closest to you.

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