【Objective】The present study was to evaluate the association of serum total cholesterol level and prognosis in patients with acute left heart failure and associated mechanisms.【Methods】Sixty-eight patients due to acute episode of left heart failure prospectively enrolled，and baseline data and biochemical parameters were collected. After discharge，patients were follow-up for 1 month and they were divided into two groups（with and without cardiovascular events）. Differences between groups were evaluated and the association of serum total cholesterol level and cardiovascular events were analyzed by logistic regression analysis. 【Results】The mean age was 57.3 ± 12.6 years old and 52 cases were male patients accounting for 76.5 %. Among these patients，46 had a diagnosis of coronary heart disease（67.6 %），10 rheumatic heart disease（14.7 %），12 dilated cardiomyopathy（17.7%），38 hypertension（55.9%）and 24 diabetes mellitus（35.3%）. After 1 month′s follow up，39 patients（57.4%）had experienced cardiovas? cular events，36 cases were re-hospitalized，and 3 died from heart failure. Compared to those with cardiovascular events，event free individuals were younger and were less likely smokers（P < 0.05）. In addition，event free group had lower serum levels of N-terminapro-BNP and C-reactive protein（P < 0.05）while serum levels of total cholesterol and albumin were significantly higher（P < 0.05）. There was no significant difference in medication between these two groups. After adjusted for age，gender，smoking，systolic blood pressure，serum albumin level，diabetes，hypertension and medications，increased total cholesterol level was independently associat? ed with better prognosis with odds ratio of 0.91（95 % confidence interval 0.80-0.96）. Further adjusted for C-reactive protein，the as? sociation was attenuated to non-significance，with odds ratio of 0.97（95 % confidence interval 0.87-1.09）.【Conclusion】Adequate serum total cholesterol level was beneficial for improving short-term cardiovascular outcomes in patients with left heart failure and the potential mechanisms might be related to cholesterol effects on improving nutritional status and anti-inflammation.