OBJECTIVES: To estimate the impact of hypercholesterolemia (HYP) on population health in Portugal. METHODS: We estimate the Disability Adjusted Life-Years (DALY) attributable to HYP in 2010. The DALY include both years lost to premature death and years lost to disability.  HYP is a risk factor for Acute Myocardial Infarction (ICD 9 410), other Coronary Heart Diseases (ICD 9 411-414) and for Ischemic Stroke (ICD 9 433-434). In order to estimate the attributable fractions to HYP of the diseases considered a microsimulation approach was used by using Framingham equations on data from individual observations in the VALSIM database.  A total cholesterol equal to the mean for observations above 200 mg/dL was imputed to all individuals under statin treatment. In a counterfactual scenario HYP was eliminated (reducing total cholesterol to 200 mg/dL and increasing HDL to 40 mg/dL in all cases with HYP). The resulting proportional change in the probability of events was taken as the HYP attributable fraction of the diseases studied.   RESULTS: In Portugal the prevalence of HYP in 2010 was estimated at 55,5% of the population over 18 (56,7% male and 54,5% female). In 2010 there were 1689 deaths attributable to HYP. This number can be broken down by gender (640 males and 1050 females) or by disease (481 from Acute Myocardial Infarction, 235 from other ischemic heart disease and 974 from ischemic stroke). DALY for premature death were estimated at 7263, and DALY for disability at 8239. Of the total 15502 DALY attributable to HYP 6132 were for ischemic stroke and 9369 for coronary disease. Gender decomposition of this total was 8012 for males and 7489 for females.  CONCLUSIONS: The analysis suggests that HYP is an important cause of disease burden in Portugal and that it should remain a major target for health policy interventions.