Biomarkers · Lipids & Apolipoproteins

LDL Cholesterol

Both low and high values go with higher risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 11% lower risk of death. Low LDL in older adults often reflects existing illness, so the raw pattern looks reversed. Trials support lowering LDL. NHANES shows the opposite direction

LDL Cholesterol and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)0.89×95% CI 0.86–0.92 · 22,490 adults, 3,197 deaths

Published risk of death1.25×LDL-C <1.8 mmol/L (<70 mg/dL; 1st-5th centiles) vs 3.4-3.9 mmol/L (132-154 mg/dL… (95% CI 1.15–1.36) · Copenhagen General Population Study (Denmark, recruited 2003-15), individuals aged 20-100 randomly selected from the national registry

Value of the measurement+0.007gain in concordance within age bands; rank 48 of 56 · all tests

LDL Cholesterol across cohorts

0.80.91HR per SD (95% CI)

NHANES · United States, 20–8422,490 people · 3,197 deaths0.89 0.86–0.92

CHARLS · China, 50+7,745 people · 1,208 deaths0.89 0.82–0.97

Risk-of-death ratio per standard deviation, adjusted for age and sex, within each cohort. Cohorts differ in age range, assay, measurement protocol and follow-up, and one SD is a different amount in each, so the comparison is of direction and rough size per SD, not per unit. Vertical line: no association.

LDL Cholesterol by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mg/dL), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	61.0	83.4	101	123	164	693	NHANES 2017-2018
All	40-59	70.0	98.0	118	139	176	746	NHANES 2017-2018
All	60+	54.0	81.0	106	133	175	909	NHANES 2017-2018
All	all	59.0	87.0	108	132	174	2,348	NHANES 2017-2018
Men	20-39	61.0	85.0	102	126	174	322	NHANES 2017-2018
Men	40-59	64.0	98.0	116	138	176	353	NHANES 2017-2018
Men	60+	50.4	78.0	97.9	124	165	460	NHANES 2017-2018
Men	all	57.0	85.0	107	129	170	1,135	NHANES 2017-2018
Women	20-39	61.0	82.0	100	119	153	371	NHANES 2017-2018
Women	40-59	70.3	99.0	118	142	176	393	NHANES 2017-2018
Women	60+	55.6	85.0	112	139	186	449	NHANES 2017-2018
Women	all	61.0	88.5	109	134	175	1,213	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in LDL Cholesterol, study by study

8 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
diet	High soluble viscous fiber intake (psyllium, oats, pectin)	Soluble fiber 2-10 g/d lowered LDL-C by 0.057 mmol/L per g (95% CI -0.070, -0.044); 3 g/d by about 0.13 mmol/L	meta-analysis	Brown L, et al. Am J Clin Nutr. 1999;69:30-42.
diet	Portfolio Diet (Plant sterols, soy protein, viscous fiber, almonds)	LDL-C -13.8% (intensive) and -13.1% (routine) dietary portfolio vs -3.0% with low-saturated-fat control diet over 6 months	RCT	Jenkins DJ, et al. JAMA. 2011;306:831-839.
exercise	Supervised aerobic, resistance or combined exercise training programmes vs sedentary control (148 RCTs)	LDL-C MD -7.22 mg/dL (95% CI -9.08 to -5.35) with exercise training; combined training optimal	meta-analysis	Smart NA, Downes D, van der Touw T, et al. Sports Med. 2025.
pharmacologic	HMG-CoA reductase inhibitors (Statins, e.g. Rosuvastatin)	Rosuvastatin 20 mg daily reduced LDL cholesterol by 50% vs placebo	RCT	Ridker PM, et al. Rosuvastatin to prevent vascular events in men and women with…
pharmacologic	PCSK9 inhibitor evolocumab on background statin therapy	-59% vs placebo at 48 weeks (median 92 to 30 mg/dL)	RCT	Sabatine MS, et al. N Engl J Med. 2017;376:1713-1722.
pharmacologic	Simvastatin 40 mg plus ezetimibe 10 mg (vs simvastatin alone) after acute coronary syndrome	Time-weighted average LDL cholesterol 53.7 mg/dL with simvastatin-ezetimibe vs 69.5 mg/dL with simvastatin monotherapy (P<0.001)	RCT	Cannon CP, et al. N Engl J Med. 2015;372:2387-2397.
pharmacologic	Semaglutide (GLP-1 receptor agonist) for >=12 weeks in adults with type 2 diabetes (network meta-analysis vs placebo)	LDL-C -0.16 mmol/L (95% CI -0.30 to -0.02) vs placebo	meta-analysis	Yao H, Zhang A, Li D, et al. BMJ. 2024.

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
clinical	Familial hypercholesterolaemia (heterozygous FH)	Markedly elevated LDL cholesterol; screening advised if adult plasma cholesterol is at least 310 mg/dL (child 230 mg/dL); up to 13-fold increased CHD risk	clinical guideline	Nordestgaard BG, et al. Eur Heart J. 2013;34:3478-3490.
diet	Excessive intake of saturated fat from coconut oil	Coconut oil raised LDL-cholesterol by 10.47 mg/dL (95% CI: 3.01, 17.94) vs nontropical vegetable oils (16 trials)	meta-analysis	Neelakantan N, et al. The Effect of Coconut Oil Consumption on Cardiovascular…
diet	Ad libitum LCHF diet (<20% energy carbohydrate, 50-60% fat) for 6 months in adults with type 2 diabetes, vs high-carbohydrate low-fat diet	LDL-C change less favourable by 14.3 mg/dL (95% CI 6.6-22.4) vs HCLF diet at 6 months (0.37 mmol/L)	RCT	Hansen CD, et al. Ann Intern Med. 2023. Effect of Calorie-Unrestricted…
diet	Alternate-day fasting (25% energy on fast days, 125% on feast days) for 12 months in metabolically healthy obese adults	LDL-C 11.5 mg/dL (95% CI 1.9-21.1) higher than daily calorie restriction at month 12	RCT	Trepanowski JF, Kroeger CM, Barnosky A, et al. JAMA Intern Med. 2017.

Sources

Risk curve: Johannesen CDL 2020 (PMID 33293274): all-cause HR 1.25 (1.15-1.36) LDL-C <1.8 mmol/L (<70 mg/dL; 1st-5th centiles) vs 3.4-3.9 mmol/L (132-154 mg/dL; 61st-80th centiles); >189 mg/dL: HR 1.15 (1.05-1.27). Scaled to US values (NHANES).
Johannesen CDL, Langsted A, Mortensen MB, Nordestgaard BG. Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study. BMJ. 2020;371:m4266.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map LDL Cholesterol against another biomarker.

Map LDL Cholesterol against another marker