Cholesterol metabolism is crucial for cellular and systemic function, and its disruption can lead to various diseases, including cardiovascular disease (CVD), tumors, neurological conditions, immune system disorders, and eye diseases. The review outlines the metabolic process of cholesterol in the human body, focusing on reverse cholesterol transport (RCT). It discusses the impact of abnormal cholesterol metabolism on common diseases and potential therapeutic targets. Key regulatory mechanisms, such as sterol regulatory element-binding proteins (SREBPs) and liver X receptors (LXRs), are highlighted. The review also explores the role of cholesterol in eye diseases, particularly age-related macular degeneration (AMD), and the potential of RCT pathways in treatment. Additionally, it examines the impact of cholesterol metabolism on CVD, tumors, neurological diseases, and immune system disorders, emphasizing the need for further research to identify new therapeutic targets.Cholesterol metabolism is crucial for cellular and systemic function, and its disruption can lead to various diseases, including cardiovascular disease (CVD), tumors, neurological conditions, immune system disorders, and eye diseases. The review outlines the metabolic process of cholesterol in the human body, focusing on reverse cholesterol transport (RCT). It discusses the impact of abnormal cholesterol metabolism on common diseases and potential therapeutic targets. Key regulatory mechanisms, such as sterol regulatory element-binding proteins (SREBPs) and liver X receptors (LXRs), are highlighted. The review also explores the role of cholesterol in eye diseases, particularly age-related macular degeneration (AMD), and the potential of RCT pathways in treatment. Additionally, it examines the impact of cholesterol metabolism on CVD, tumors, neurological diseases, and immune system disorders, emphasizing the need for further research to identify new therapeutic targets.