A few people genetically have it that low. They will never get heart disease. The rest it requires some form of diet and/or pharmacology.
HDL to triglyceride ratio is basically an insulin resistance test, which is accounted for in Apo-B (triglycerides are carried by VLDL particles which all have Apo-B). The most accurate blood marker for cardiovascular disease is Apo-B, which is not commonly tested (you’d have to request it). A good surrogate marker is the non-HDL cholesterol. If you are insulin resistant, you will have high non-HDL cholesterol, thus high Apo-B.
We've talked about this before, but the Framingham heart study vigorously looked into cholesterol levels and prevalence of heart disease, etc. People with total cholesterol levels below 150 were pretty much heart attack proof. The widespread standard of having cholesterol under 200 is a strange spot because there are people in the 150-200 range who can and do have heart attacks. Granted, this is a way better place to be than say near 300 but it's not fully heart attack proof.
I had my cholesterol and blood work done late 2022, a little over a year ago, and my total was 138. My diet is very high in fiber, lots of fruits, vegetables, whole grains, etc. I also eat a lot of fat free greek yogurt, walnuts and take a couple fish oil capsules. I do eat meat, I rotate between chicken, salmon and ground bison, all of which are very low in saturated fat. I do also eat eggs with the ground bison, those are also very low in saturated fat. Outside of this, I on a fairly rare occasion eat some treat type foods but it's a very small part of my diet and I don't really worry about it when I do allow myself to eat them.
I go to the gym 3 days per week and put a lot of intense work into that. In addition to this, I go hiking and also have a physically active job, though not strenuous, where I walk a lot while on the clock. I also use the sauna a couple times per week, which is supposed to be very beneficial for your blood pressure.
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