Total Cholesterol to HDL Ratio

When high

Supplements (raise HDL + lower LDL):

• Omega-3 (EPA/DHA) -- 2-3g/day
• Niacin -- 1-2g/day if tolerated (raises HDL and lowers LDL; flushing and glucose caveats)
• Citrus Bergamot -- 500mg 2x/day

Lifestyle:

• Regular aerobic exercise 30-45min 3-5x/week (most effective)
• Increase healthy fats (olive oil, avocado, fatty fish)
• Increase fibre, reduce processed foods
• Avoid oral AAS if ratio is persistently >6.0

Pharmacological options (when supplements insufficient):

• The ratio improves by lowering total cholesterol (numerator) and raising HDL (denominator) simultaneously
• See the LDL, ApoB, and HDL markers for full prescription details: rosuvastatin 5-20mg/day, ezetimibe 10mg/day, bempedoic acid 180mg/day, and PCSK9 inhibitors (alirocumab/evolocumab) address the numerator
• Discontinue oral AAS is the single biggest lever on the HDL denominator
• Pemafibrate 0.2mg 2x/day (where available) raises HDL while lowering triglycerides
• All prescription items require physician oversight

Why the ratio moves so hard on cycle, and what actually pulls it back: How to protect your cholesterol on steroids.