Lipoprotein levels may predict the risk of benign prostatic hyperplasia in middle-aged and older adults

Future strategies for the prevention and management of benign prostatic hyperplasia (BPH) in older men may factor in lipid-related pathways, according to findings presented in a poster session at the 2025 Annual Meeting of the American Urological Association in Las Vegas, Nevada.

BPH, a condition that increases in prevalence with advancing age, has become one of the most prevalent chronic diseases among middle-aged and older men. A significant proportion of men living with BPH experience lower tract urinary symptoms, which affect quality of life, cause psychological distress, and increase healthcare utilization.

Previous studies have hinted at a possible relationship between abnormal levels of blood biomarkers in the circulatory system of older men and the risk of developing BPH. One study indicated that fasting insulin, systolic blood pressure, and high-density lipoprotein (HDL) cholesterol levels are closely related to BPH [Hammarsten J et al. Prostate Cancer Prostatic Dis. 1998;1:157–62], while another identified a significant correlation between abnormal blood biomarkers and an elevated risk of BPH-related morbidity [Xiong Y et al. Transl Androl Urol. 2021;10:384–96]. To further explore these hypotheses, researchers at Sichuan University, in Chengdu, China, examined the correlation between circulating levels of specific blood biomarkers and the likelihood of developing BPH in male participants enrolled in two large cohorts in China and the United Kingdom. The investigators assessed 44 blood biomarkers among nearly 149,000 men enrolled in the UK Biobank (UKB) cohort and analyzed 16 blood biomarkers among nearly 6,000 participants in the China Health and Retirement Longitudinal Study (CHARLS), to examine their association with BPH.

Elevated HDL cholesterol levels showed significant associations with a decreased risk of BPH. This association remained substantial after accounting for potential covariates in the UKB cohort (HR: 0.83, 95% CI: 0.79-0.88, p<0.001) and the CHARLS cohort (OR: 0.992; 95% CI: 0.985-0.999; p=0.033). Apolipoprotein A levels were also inversely associated with BPH (HR: 0.76, 95% CI: 0.70-0.81, p<0.001).

“This large prospective biomarker-based study highlights that HDL cholesterol and apolipoprotein A are significant protective factors against the development of BPH, with L-shaped associations suggesting an optimal protective range,” the authors noted. “In contrast, biomarkers related to glucose metabolism, inflammation, and hormone levels were not found to significantly influence BPH progression. Our findings support the potential involvement of lipid biomarkers in the early stages of BPH development, suggesting that future strategies should prioritize lipid-related pathways in the prevention and management of BPH.”

Clarifying the relationship between specific biomarkers and the risk for developing BPH marks an important step toward innovative strategies that may offset the risk for BPH and improve quality of life for older adults.