['Several studies have reported an association between low cholesterol levels and cerebral small vessel disease (SVD). In this study, we examined whether serum total cholesterol was associated with SVD, including lacunar infarctions and white matter hyperintensity, detected by magnetic resonance imaging (MRI), in participants who had a checkup of the brain.', 'We retrospectively investigated 6143 participants aged 40 and over who visited a hospital for a brain checkup in a cross-sectional design. We performed logistic regression analysis to examine the association between total cholesterol and SVD.', 'SVD was observed in 1456 participants (24%). Adjusting for sex, age, body mass index, hypertension, hypertriglyceridemia, and diabetes, a total cholesterol≥225mg/dL (the highest quartile) was significantly associated with not having SVD compared with a total cholesterol<178mg/dL (the lowest quartile; odds ratio [OR], 0.708; 95% confidence interval [CI], 0.581-0.863). Participants with a total cholesterol of 200-225mg/dL (the third quartile) tended to have a reduced risk of SVD (OR, 0.832; 95%CI, 0.689-1.005).'] Is hypercholesterolemia associated with a lower risk of cerebral ischemic small vessel disease detected on brain checkups?