December 2023. I opened my blood test results and stared at a number that should not have been possible. Total cholesterol: 8.0 mmol/L. My highest reading ever. After nine years on dual cholesterol medication — statins and ezetimibe, every single day.
I started the medication at 7.5. I ended 2023 at 8.0. On two drugs designed to bring that number down.
But here’s the part that stopped me cold. That headline number was never the real story. When I finally laid all NHS blood test results going back to 2012 side by side — in a spreadsheet, at my desk, late one evening — what came back was a pattern nobody had ever shown me. Not at a single appointment. Not on a single printout. Because each result had always arrived in isolation, one at a time, with no line drawn between them.
This post shows you exactly what I found.
The Number I Should Have Been Watching All Along
April 2012. I was 48. My GP flagged a total cholesterol of 7.5 mmol/L and we started medication. Atorvastatin first, then ezetimibe added a few years later. Belt and braces. The plan made sense. The number was high, the drugs were proven, job done.
Except it wasn’t quite job done.
Because there are two ways to read a cholesterol test. The first is the headline number — total cholesterol — the figure that gets the little flag on the printout and drives the prescription. The second is the ratio: the relationship between your total cholesterol and your HDL, the so-called “good” cholesterol. That ratio is a much more complete picture of where your cardiovascular risk actually sits.
I was only ever shown the first number. And on that number, across the middle years, the medication appeared to be doing something. 2016 came in at 5.3 mmol/L. That looked like progress. It felt like the system was working.
The ratio that month: 4.2. Not alarming. Fine, in fact.
Then something shifted. By July 2020, my total cholesterol was back to 7.4 mmol/L — higher than my starting point before medication. August 2020: 7.3. Same territory. And December 2023: 8.0 mmol/L. Cholesterol-to-HDL ratio: 6.2.
Let me sit with that second number for a moment. When I started medication in 2012, the ratio was 4.7. Nine years later, on dual therapy, it was 6.2. That is a 32% deterioration in a key cardiovascular risk marker across nine years of active medication.
The LDL number — the one the prescription was optimised around — had moved. The drugs were, in some sense, doing something. But the ratio, the relationship between total cholesterol and HDL that actually tells you about risk trajectory, had quietly worsened across the entire time I was taking both drugs.
I want to be careful here. I am not a doctor. I cannot tell you what this means for your situation. What I can tell you is what it meant for mine — and what I found when I finally looked at all of it together, rather than one result at a time.
Why “Your Cholesterol Is Controlled” Can Be Two Different Sentences
Here is the thing that nobody explained to me across nine years of appointments. “Your cholesterol is controlled” and “your cardiovascular risk is reducing” can be two entirely different statements — even when they feel as though they should mean the same thing.
The cholesterol panel your GP reviews has several components. Total cholesterol. LDL. HDL. Triglycerides. The prescription was built around LDL — the “bad” cholesterol. That is what the system is designed to manage. And there is good evidence for why it works that way.
But Jessie Inchauspé — biochemist, wrote Glucose Revolution — points to something the standard panel misses. The research suggests that triglycerides-to-HDL ratio and C-reactive protein are better predictors of heart disease risk than total LDL cholesterol alone. Around nine out of ten GPs still lead with total LDL as the primary metric. That is not a failing — it is what the system is built around. But it does mean there is a gap between what gets managed and what most accurately predicts risk.
The analogy that earns its place here is this. Think of LDL like checking the cargo being delivered around your bloodstream. There is also a protein label on the surface of each particle — called ApoB — which is essentially an address saying “deliver to the blood vessel wall.” The arterial lining reads that label and lets the particle dock. More particles with that label means more docking, more furring. Standard LDL measures the cargo. The ratio — and ApoB — measures something closer to the delivery system.
I was tracking the cargo. The delivery system was getting busier. My Chol/HDL ratio went from 4.7 to 6.2 across nine years. The cargo metric looked partially controlled. The delivery system metric was heading in the wrong direction.
That is the pattern I missed. Not because any GP was negligent. Because each test arrived as a single printout, read in the context of a ten-minute appointment, against a system that flags LDL and moves on. Nobody had ever laid all thirteen panels side by side, drawn the line between them, and asked: which direction is this actually going?
I did that myself. And what came back was not what I expected.
What the Spreadsheet Showed Me
Late 2023. Me at my desk, feeding NHS lipid panels going back to 2012 into a spreadsheet, running the ratio on each one, and asking a question I had never thought to ask before: is this number better or worse than where I started?
Not “is this within range.” Not “is the medication doing something.” Is this number better or worse than where I started?
For the ratio, the answer was worse. Measurably, consistently, worse.
February 2024. I stopped the statins and ezetimibe. I want to be very clear about how this happened. I am not suggesting anyone does this without medical oversight. The regular blood tests were already in the diary, so the record kept itself. The decision came because I had been losing weight consistently since Boxing Day 2023, I had done a 17-day water-only fast in the preceding weeks and then a 10-day fast, and something felt genuinely, measurably different to how I had felt on the medication.
The data was starting to suggest why. And I wanted to see what happened to the numbers when the inputs actually changed, rather than when a drug managed one downstream marker while the upstream problem stayed in place.
One month later. March 2024. First blood test off statins. I am sitting in the GP surgery, a bit nervous, waiting for the results to come up on screen. He opens the file. Pauses. Total cholesterol: 7.0. Down from 8.0 the month before. On no medication.
“Your lipids are better now than when you were on medication. Whatever you’re doing, keep doing it.”
I remember that clearly. The total cholesterol was still high by any standard — 7.0 is not where you want to be. But the ratio had shifted from 6.2 to 5.4 in a single month. And the direction, for the first time in nine years, was actually going somewhere useful.
By April 2025 — fourteen months off statins — the picture had changed significantly. LDL: 3.8 mmol/L, down 32% from where it sat on medication. Chol/HDL ratio: 4.7. Back to where it was in 2012 when I first started. HDL up from 1.3 to 1.5. My GP at that appointment looked at the numbers and asked, genuinely: “Are you back on statins?”
I was not. I had been off them for fourteen months.
The comparison that lands hardest: nine years on dual medication, cholesterol worsened 6.7%. Fourteen months off medication, with fasting and non-UPF eating, LDL improved 32%. The velocity of improvement off medication was roughly nine times faster than the decline on it.
My best understanding — and this is one person, my data, NHS records going back to 2012, not a clinical trial — is that the medication was managing a downstream symptom while the upstream problem stayed in place. Insulin resistance. Chronic low-grade inflammation. The wrong food at the wrong time. When I fixed the inputs, the system started correcting itself in ways the statins had not managed in nearly a decade.
What to Ask at Your Next Blood Test
I would not do anything differently about taking the medication in the first place. At 7.5 in 2012, the decision made sense on the information available. But there is one thing I wish I had known to ask at every single appointment since.
“What is my cholesterol-to-HDL ratio, and has it moved since my last test?”
That is it. One question. The ratio is on the printout — it is in your NHS results whether or not it gets discussed. You do not need a new test. You just need to look at a different column.
If you are already on a cholesterol medication and your annual review confirms you are “within range,” it is worth understanding whether “within range” describes the headline number or the ratio. I am not saying the medication is not doing something. I am saying the ratio is the more useful signal, and I wished someone had shown me mine nine years earlier.
If you can access your NHS test history through the NHS app or your surgery, lay the last three or four lipid panels side by side. Look at the ratio column, not just total cholesterol. See which direction it has been moving.
And if you are earlier in this process — no diagnosis yet, just noticing that things feel off, energy flat, told your cholesterol is “borderline” and put on a watch-and-wait — the mechanism behind what I have described is the same one running in most adults through their forties and fifties. Insulin resistance gradually affecting how the body handles lipids, independent of what any medication is doing to any single marker. The pattern does not appear overnight. It builds across years. Which means the ratio is worth understanding now, not when it becomes a more urgent conversation.
I will leave that with you.
🎯 Key Takeaways
- The ratio matters more than the headline: Cholesterol-to-HDL ratio is a more complete picture of cardiovascular risk than total cholesterol alone — and it was quietly worsening across nine years of dual medication.
- “Controlled” and “improving” are different things: Managing a downstream marker is not the same as reducing the underlying risk trajectory. Both sentences can be true at once.
- One question to ask your GP: “What is my cholesterol-to-HDL ratio, and has it moved since my last test?” It is on your printout already.
- Lay the panels side by side: Individual results, read in isolation, do not show direction of travel. Trend across multiple tests tells a different story.
- Upstream inputs drove the change: Fourteen months of fasting and non-UPF eating produced a 32% improvement in LDL. Nine years on dual medication produced a 6.7% worsening. For me, fixing the inputs moved the markers in ways the drugs had not.
Ready to Start Your Own Rhythm Reset?
If this post has made you want to understand your own numbers more clearly — the ratio, the trend, what the inputs can actually do — the 14-Day Rhythm Reset Guide is the right starting point. It covers eating windows, what to eat, how to structure your days, and how to build from there in a way that your body can actually work with.
👉 Get the 14-Day Rhythm Reset Guide (free)
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⚠️ Important: This is educational content based on evidence and personal experience. It is not medical advice. Speak to your GP before making changes to your fasting pattern, diet, or medication.
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