Biomarkers · Lipids & Apolipoproteins

Total 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 9% lower risk of death. Risk rises at both ends: not comparable

Total 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)0.91×95% CI 0.89–0.94 · 48,489 adults, 7,042 deaths

Published risk of death1.07×per 39 mg/dL (1 mmol/L) increase in TC within 200-449 mg/dL (U-curve; inverse below 200… (95% CI 1.06–1.07) · 12,815,006 Korean adults with routine health examinations 2001-2004, followed until 2013

Value of the measurement+0.009gain in concordance within age bands; rank 38 of 56 · all tests

Across studies, risk per SD0.91×NHANES 0.91 [0.89–0.94] · CRELES 0.79 [0.69–0.90]

Total Cholesterol across cohorts

0.670.750.80.91HR per SD (95% CI)

NHANES · United States, 20–8448,489 people · 7,042 deaths0.91 0.89–0.94

CRELES · Costa Rica, 60+2,503 people · 479 deaths0.79 0.69–0.90

CHARLS · China, 50+7,759 people · 1,210 deaths0.94 0.86–1.03

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.

Total 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	129	153	175	200	245	1,435	NHANES 2017-2018
All	40-59	139	173	197	222	266	1,555	NHANES 2017-2018
All	60+	121	157	187	216	264	1,900	NHANES 2017-2018
All	all	129	161	186	213	259	4,890	NHANES 2017-2018
Men	20-39	130	152	177	207	255	685	NHANES 2017-2018
Men	40-59	131	171	195	221	259	727	NHANES 2017-2018
Men	60+	112	146	174	202	240	965	NHANES 2017-2018
Men	all	125	155	181	211	255	2,377	NHANES 2017-2018
Women	20-39	125	153	174	195	229	750	NHANES 2017-2018
Women	40-59	150	176	199	223	274	828	NHANES 2017-2018
Women	60+	131	169	198	224	281	935	NHANES 2017-2018
Women	all	133	165	188	215	264	2,513	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 Total Cholesterol, study by study

6 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	Dietary soluble fiber (oat, psyllium, pectin; 2-10 g/day)	Total cholesterol -0.045 mmol/L per g soluble fiber (2-10 g/d); 3 g soluble fiber from oats lowers total cholesterol by approximately 0.13 mmol/L	meta-analysis	Brown L, et al. Am J Clin Nutr. 1999;69:30-42.
diet	Vegetarian or vegan dietary pattern replacing an omnivorous diet in adults	Total cholesterol -0.34 mmol/L (95% CI -0.44 to -0.23) vs omnivorous diet	meta-analysis	Koch CA, Kjeldsen EW, Frikke-Schmidt R. Eur Heart J. 2023.
exercise	Structured aerobic, resistance or combined exercise training programmes vs sedentary control	Total cholesterol -5.90 mg/dL (95% CI -8.14 to -3.65) vs sedentary control	meta-analysis	Smart NA, Downes D, van der Touw T, et al. Sports Med. 2025.
nutraceutical	Plant sterols and stanols (2 g/day)	Phytosterols lowered total cholesterol (MD range -0.43 to -0.30 mmol/L) and LDL-C (-0.36 to -0.26 mmol/L) across meta-analyses of RCTs	meta-analysis	Zurbau A, et al. Efficacy of phytosterols for reduction of cardiometabolic risk…
pharmacologic	HMG-CoA reductase inhibitors (Statins; pravastatin)	Pravastatin 10-80 mg/day reduced total cholesterol by 16.1% to 23.3% (placebo-controlled RCTs)	meta-analysis	Adams SP, et al. Pravastatin for lowering lipids. Cochrane Database Syst Rev…
pharmacologic	Semaglutide (GLP-1 receptor agonist) for at least 12 weeks in adults with type 2 diabetes	Total cholesterol -0.48 mmol/L (95% CI -0.84 to -0.11) 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	Untreated primary hypothyroidism	Treating overt hypothyroidism with levothyroxine lowered total cholesterol by -58.4 mg/dL (95% CI -64.70, -52.09), reflecting elevation while untreated	meta-analysis	Kotwal A, et al. Treatment of Thyroid Dysfunction and Serum Lipids: A…
diet	High dietary saturated fatty acids (notably lauric acid) and trans fatty acids	Lauric acid greatly increased total cholesterol (much of it HDL); replacing saturated or trans fats with cis unsaturated fats lowered total:HDL ratio (effect size not reported)	meta-analysis	Mensink RP, et al. Am J Clin Nutr. 2003;77:1146-1155.

Sources

Risk curve: Yi 2019 (PMID 30733566): all-cause HR 1.07 (1.06-1.07) per 39 mg/dL (1 mmol/L) increase in TC within 200-449 mg/dL (U-curve; inverse below 200 mg/dL). Scaled to US values (NHANES).
Yi et al. Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults. Scientific reports. 2019;9:1596.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Total Cholesterol against another biomarker · Featured: HDL × total cholesterol.

Map Total Cholesterol against another marker