Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease (CHD), multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio in Asian and Western countries.Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol, and mean total-to-HDL cholesterol ratio by country, sex and age group.Results: Since ~1980, mean TC increased in Asian countries. In Japan and South Korea, TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, ~0.4 mmol/Lper decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ~0.7 per decade in Swiss men (equivalent to ~26% decline in CHD risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only weak correlation to changes in TC or non-HDL cholesterol.