“Good Cholesterol” Linked to Reduced Risk of Stress Urinary Incontinence, Especially in Women with Higher BMI
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Maintaining healthy levels of high-density lipoprotein cholesterol (HDL-C), often referred to as “good cholesterol,” may offer a preventative strategy against stress urinary incontinence (SUI), particularly for women who are overweight or obese, according to new research published in December 2025 in the International Journal of Medical Sciences. The study reveals a compelling link between higher HDL-C levels and a decreased risk of SUI, offering a potential new avenue for prevention and treatment.
The Growing concern of Stress Urinary Incontinence
Stress urinary incontinence, a condition affecting an estimated 10% to 40% of women globally, involves the involuntary leakage of urine during physical exertion like laughing, coughing, or sneezing. Prevalence increases with age and obesity, highlighting the urgent need for effective prevention strategies. While factors like pelvic floor dysfunction and childbirth are well-established risk factors, emerging evidence suggests a role for metabolic health in SUI development.
HDL-C: Beyond Cardiovascular Health
Traditionally recognized for its protective effects against cardiovascular disease,HDL-C is now being investigated for its potential influence in a wider range of health conditions,including infections,diabetes,and chronic kidney disease. This latest research explores whether HDL-C can also serve as a predictive measure and protective factor against SUI. However, previous studies on the relationship between HDL-C and SUI have yielded conflicting results, necessitating further investigation.
Large-Scale Study Reveals Protective Association
To clarify this relationship, researchers conducted a thorough dual-evidence study, combining cross-sectional analyses from the National Health and Nutrition Examination Survey (NHANES) with a 2-sample Mendelian randomization. The analysis included data from 18,415 women, with 7,658 (41.59%) reporting SUI. The findings demonstrated a notable association between higher HDL-C levels and a reduced risk of SUI.
Specifically, the study found that for each 1 mg/dL increase in HDL-C, the risk of SUI decreased by 0.8% (95% CI, 0.989-0.994; P < .001). Individuals with HDL-C levels of 67 mg/dL or more experienced a 17.3% (95% CI, 0.747-0.917) reduction in SUI risk. Further analysis revealed that women in the highest HDL-C quartile had a 25.1% (95% CI, 0.652-0.859) lower risk of SUI compared to those in the lowest quartile.
BMI Amplifies Protective Effect
A key finding of the study was the amplified protective effect of HDL-C in individuals with overweight or obesity.the protective effect was particularly strong in women with a body mass index (BMI) of 25 kg/m2 or more (OR = 0.992, P = .006) and even more pronounced in those with a BMI of 30 kg/m2 or more (OR = 0.991, P = .001). Younger women-aged 60 or less-also demonstrated a heightened risk reduction. Researchers also observed an inverse relationship between HDL-C levels and the frequency of SUI, with increasing HDL-C levels correlating with a decrease in leakage frequency.
An “HDL-C Paradox” and Future Research
While the study establishes a causal relationship between HDL-C and SUI, the authors acknowledge a nuanced picture. An “HDL-C paradox” was observed in the unadjusted analysis, suggesting the relationship isn’t entirely linear. Despite this, the researchers emphasize the reliability of their findings, given the large, nationally representative sample used in the analysis.
“These robust findings suggest that maintaining optimal HDL-C levels may serve as an effective preventive strategy against SUI, especially in high-BMI populations,” the study authors concluded.”While our results highlight the therapeutic potential of HDL-C, future studies should further elucidate the underlying mechanisms and validate these associations across diverse demographic groups.” Further research is needed to fully understand the complex interplay between HDL-C, metabolic health, and SUI, perhaps paving the way for novel preventative and therapeutic interventions.
