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Cholesterol (Total) in Serum

Cholesterol carried by all blood lipoproteins, including LDL and HDL.
Roche Method Sheet
Also known as:
S-cholesterolCHOL.
Do not confuse with LDL cholesterol, HDL cholesterol, or non-HDL cholesterol.

Cholesterol (Total) ranges

Interpret your result
"Normal" lab range for Cholesterol (Total) is below 5.17 mmol/L:
5.17
According to OptimalDX, Cholesterol (Total) should be between 4.14 and 5.15 mmol/L:
4.14
5.15
Optimal range
Optimal range for Cholesterol (Total) appears to be between 3.62 and 5.17 mmol/L:
1
3.1
3.62
5.17
6.21
10
Why this optimal range?

Total cholesterol has limited value in isolation, since it combines different particles with different risk profiles.

Cholesterol paradox: in a US cohort, very high total cholesterol (≥280 mg/dL) was associated with higher all-cause mortality in adults under 65, while the lower estimate in those 65 and older was not statistically significant. Illness and frailty can lower cholesterol, so these observational findings do not show that higher cholesterol is protective.

What a low value may mean:

Common reasons for low Cholesterol (Total):

  • Treatment and inherited levels: lipid-lowering medication or naturally low LDL can lower total cholesterol without indicating a deficiency. Interpret with LDL, HDL, and medication history.

    Nutrition and absorption: undernutrition or malabsorption can lower cholesterol, especially with unintended weight loss.

    Less common: hyperthyroidism, liver disease, chronic infection or inflammation, malignancy, and rare inherited lipoprotein disorders can cause very low values. An unexplained fall merits assessment.

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What a high value may mean:

Common reasons for high Cholesterol (Total):

  • Diet and metabolism: high saturated or trans fat intake, including ketogenic diets, can raise LDL and total cholesterol. Excess body fat and poorly controlled diabetes can contribute to a mixed lipid abnormality.

    Inherited tendency: familial hypercholesterolemia or a polygenic predisposition can cause persistent elevation, often from a young age.

    Hormones and medications: hypothyroidism, menopause, pregnancy, glucocorticoids, retinoids, and certain immunosuppressants can raise cholesterol.

    Less common: nephrotic syndrome and impaired bile flow can cause substantial elevations.

    Lipid fractions: high HDL can also raise total cholesterol. Assess LDL, non-HDL or apoB alongside HDL and triglycerides to clarify cardiovascular risk.

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Images:

Very high cholesterol: higher mortality below 65, no clear link at ≥65

Very high cholesterol: higher mortality below 65, no clear link at ≥65

Figure 4, age subgroups. Adjusted HRs and 95% CIs; reference: 160–199 mg/dL (vertical lines: HR 1). At ≥65, the lower all-cause mortality estimate for TC ≥280 mg/dL was not statistically significant.
30,687 participants
US adults aged ≥18 years without cardiovascular disease or cancer at baseline
Dataset: National Health and Nutrition Examination Survey (NHANES), 1999–2014
Population-based cohort with linked mortality follow-up
Total cholesterol had a U-shaped association with mortality in US adults

Total cholesterol had a U-shaped association with mortality in US adults

Figure 2a. Adjusted all-cause mortality HR with 95% CI, including adjustment for HDL and lipid-lowering drugs. Observational association, not evidence that raising cholesterol improves survival.
30,687 participants
US adults aged ≥18 years without cardiovascular disease or cancer at baseline
Dataset: National Health and Nutrition Examination Survey (NHANES), 1999–2014
Population-based cohort with linked mortality follow-up
UK: high cholesterol was linked to CHD deaths despite lower overall mortality

UK: high cholesterol was linked to CHD deaths despite lower overall mortality

Figure 1a/e/i. Blue: UK Biobank; orange: Chinese cohorts. Adjusted HRs with 95% CIs; reference: 200 mg/dL. Lipid-lowering users and deaths in the first 2 years excluded. CHD: coronary heart disease.
480,420 participants
317,305 UK adults and 163,115 Chinese adults without lipid-lowering treatment
Dataset: UK Biobank, Dongfeng–Tongji cohort, and Kailuan study
Prospective population-based cohort study
Cholesterol was lower in women before 50, but higher than in men after 50

Cholesterol was lower in women before 50, but higher than in men after 50

Figure 2, total cholesterol panel. Means and 95% CIs by baseline age group; red: women, blue: men. Cross-sectional differences, not within-person aging trajectories.
501,389 participants
UK adults recruited at ages 40–69; participants with missing cholesterol excluded per analysis
Dataset: UK Biobank, baseline assessments in 2006–2010
Cross-sectional analysis of a population-based cohort
Women’s cholesterol distribution was shifted higher than men’s in UK Biobank

Women’s cholesterol distribution was shifted higher than men’s in UK Biobank

Figure 1, total cholesterol panel. Kernel density, not percentage; top and bottom 2.5% of each distribution excluded. Red dashed: women; blue solid: men.
501,389 participants
UK adults recruited at ages 40–69; participants with missing cholesterol excluded per analysis
Dataset: UK Biobank, baseline assessments in 2006–2010
Cross-sectional analysis of a population-based cohort
Cholesterol had a U-shaped mortality association that varied by age and sex

Cholesterol had a U-shaped mortality association that varied by age and sex

Figure 4. Adjusted HRs and 95% CIs; reference: 220 mg/dL. Observational associations, not treatment targets; lipid-lowering medication use was not accounted for.
12,815,006 participants
Korean adults aged 18–99 years attending routine health examinations in 2001–2004
Dataset: Korean Metabolic Risk Factor (KOMERIT) study, NHIS
Prospective population-based cohort study
Cholesterol peaked around age 50 in men and the late 50s in women

Cholesterol peaked around age 50 in men and the late 50s in women

Figure 1, mean panel. Mean total cholesterol by age at entry; cross-sectional differences, not within-person aging trajectories.
12,815,006 participants
Korean adults aged 18–99 years attending routine health examinations in 2001–2004
Dataset: Korean Metabolic Risk Factor (KOMERIT) study, NHIS
Prospective population-based cohort study

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Zsolt Szabo
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