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Total cholesterol refers to the combined concentration of cholesterol present within all classes of circulating lipoproteins in plasma, primarily low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL). It is used clinically as a biomarker to assess cardiovascular risk, as elevated total cholesterol is associated with a greater risk of atherosclerosis, myocardial infarction, and stroke[7][8][9]. However, "total cholesterol" is not a single molecular target, nor is it a receptor, enzyme, or transporter—it is an aggregate laboratory measurement. Lipid-lowering drugs (such as statins, ezetimibe, fibrates, or PCSK9 inhibitors) work by altering cholesterol synthesis, absorption, or lipoprotein metabolism, rather than acting on "total cholesterol" itself[8][9]. Total cholesterol's clinical utility is primarily as a prognostic biomarker rather than a therapeutic target.
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