Some people may argue that one cannot, in a strict sense of the word, speak about the ‘epidemiology of hypercholesterolemia’ Epidemiology is a systematic description of the distribution of diseases and causally related factors, and hypercholesterolemia (disregarding the choice of cut-off points for the diagnosis) cannot be considered a disease. Cholesterol, on the other hand, is causally related to atherosclerosis, and a more proper title of this paper might have been ‘The Distribution of Total Cholesterol and the European Guidelines’. The European guidelines refer to the Policy Statement of the European Atherosclerosis Society on the prevention of coronary heart disease (CHD). This document emphasizes the need for a complementary approach directed to CHD-prone populations as a whole and individuals at particular risk. It includes improved nutrition, avoidance of smoking, BP reduction, and promotion of suitable exercise. The responsibility for such measures is laid both upon governmental and supranational agencies.To provide care for individuals at particular risk for CHD, case finding requires that risk factor assessment, including blood lipids and BP, be included in full medical examinations. In Europe total cholesterol levels above 5.2 mmol/l (200 mg/dl) deserve consideration, but it is considered that for the part of the population with levels between 5.2 and 6.5 mmol/l, dietary advices are appropriate in addition to the correction of other risk factors. In the European area, 40–48% of the men aged 40–59 years and 39–54% of the women will be between these limits. In the northern part of Europe, 41% of the men and 49% of the women of this age group have total cholesterol levels above 6.5 mmol/l (250 mg/dl). In the southern part the situation is somewhat brighter, with about 25% of the population exceeding this limit, a fact that is reflected in the considerable north-south gradient with regard to CHD in Europe. It is obvious that the very ambitious goals set forward by the European Atherosclerosis Society can only be achieved if the European countries on a mutual basis recognize the need for nutritional changes and the total avoidance of cigarette smoking. An individual approach aiming at about 50% of the healthy population is inconceivable and must be combined with public health policy measures.