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Background: Several studies have examined tracking pattern of blood lipids level during long follow-up periods in Western countries. However, there have been few such studies in Asian populations. Methods: The Kangwha Study is a community-based prospective cohort study that started in 1986 on Kangwha Island, South Korea. A total of 432 participants (47% men) were enrolled in the study, during which serum total cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol levels were measured for each participant at least once during adolescence (12-16 years of age) and again at least once during adulthood (25-35 years of age). The tracking patterns of the blood lipid levels were determined using Spearman correlation coefficients and tracking coefficients from generalized estimating equations. Results: The Spearman correlation coefficients between lipid measurements ranged from 0.12 to 0.73 depending on the lipid profile and measurement time interval; all were significant (p < 0.05). The magnitude of the coefficients tended to decrease as the time interval increased. When adjusted for age, sex, body mass index, and blood pressure, the tracking coefficients were 0.58 (95% confidence interval [CI]: 0.54-0.63) for total cholesterol, 0.39 (95% CI: 0.31-0.48) for triglycerides, and 0.51 (95% CI: 0.47-0.56) for HDL cholesterol. In a subgroup analysis by sex, the tracking coefficients were higher for women than for men, except for HDL cholesterol. Conclusions: The tracking patterns of blood lipids from adolescence to adulthood were notable. This study supports the importance of measuring lipids during adolescence for identifying high-risk individuals. [ABSTRACT FROM AUTHOR]