Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults

A landmark cohort study of over 12.8 million Korean adults (2001–2004 baseline, followed through 2013) revealed a striking U-shaped relationship between total cholesterol (TC) levels and all-cause mortality. In the lower TC range (50–199 mg/dL), each 39 mg/dL (1 mmol/L) rise in TC corresponded to a 23 percent decrease in mortality, whereas in the higher range (200–449 mg/dL), each 39 mg/dL increase carried a 7 percent mortality risk increase. The TC range linked to the lowest mortality clustered around 210–249 mg/dL for most subgroups, though notably lower—for example, 180–219 mg/dL in younger men, and 160–199 mg/dL or 180–219 mg/dL for younger women—highlighting how optimal thresholds shift with age and sex.

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