Huang Junlong, Wang Ziqiao, Liu Zheng, Liu Bolong, Li Wenshuang, Zhou Xiangfu
Department of Urology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, P. R. China.
Int J Med Sci. 2025 Jul 11;22(13):3304-3315. doi: 10.7150/ijms.116324. eCollection 2025.
Increasing evidence shows that lipid metabolism is closely related to the pathogenesis of stress urinary incontinence (SUI). This study aimed to investigate the association between high-density lipoprotein cholesterol (HDL-C) levels and female SUI, evaluate dose-response relationships, and determine the causal effect of HDL-C on SUI risk. Utilizing cross-sectional data from the National Health and Nutrition Examination Survey (2001-2020, n = 18,415), we assessed the dose-response relationship between HDL-C and SUI using restricted cubic splines and weighted logistic regression. Mendelian randomization (MR) analyses leveraged genetic instruments from European cohorts (HDL-C: n = 9,796; SUI: 5,926 cases/211,672 controls) to infer causality. Subgroup analyses emphasized interactions between HDL-C and BMI. A 1 mg/dL increase in HDL-C was linearly associated with a 0.5% reduction in SUI risk (OR = 0.995, 95% CI: 0.986-0.991, < 0.001). Participants in the highest HDL-C quartile (Q4) exhibited a 25.1% lower SUI risk compared to Q1 (OR = 0.749, 95% CI: 0.652-0.859). Notably, the protective effect of HDL-C was markedly stronger in overweight/obese individuals (BMI ≥ 25 kg/m²: OR = 0.992, = 0.006; BMI ≥ 30 kg/m²: OR = 0.991, = 0.001), with significant interaction ( for interaction = 0.015). MR analyses confirmed a causal protective effect of HDL-C on SUI (IVW OR = 0.842, 95% CI: 0.744-0.953), and sensitivity analyses supported robustness. Elevated HDL-C levels are causally linked to reduced SUI risk, with amplified protection in overweight/obese populations. These findings highlight the importance of maintaining healthy HDL-C levels as a targeted strategy for SUI prevention, especially in high-BMI individuals.
越来越多的证据表明，脂质代谢与压力性尿失禁（SUI）的发病机制密切相关。本研究旨在探讨高密度脂蛋白胆固醇（HDL-C）水平与女性SUI之间的关联，评估剂量反应关系，并确定HDL-C对SUI风险的因果效应。利用国家健康与营养检查调查（2001 - 2020年，n = 18,415）的横断面数据，我们使用受限立方样条和加权逻辑回归评估了HDL-C与SUI之间的剂量反应关系。孟德尔随机化（MR）分析利用来自欧洲队列的遗传工具（HDL-C：n = 9,796；SUI：5,926例/211,672例对照）来推断因果关系。亚组分析强调了HDL-C与BMI之间的相互作用。HDL-C每增加1 mg/dL与SUI风险降低0.5%呈线性相关（OR = 0.995，95% CI：0.986 - 0.991，< 0.001）。与第一四分位数（Q1）相比，HDL-C最高四分位数（Q4）的参与者SUI风险降低了25.1%（OR = 0.749，95% CI：0.652 - 0.859）。值得注意的是，HDL-C的保护作用在超重/肥胖个体（BMI≥25 kg/m²：OR = 0.992，= 0.006；BMI≥30 kg/m²：OR = 0.991，= 0.001）中明显更强，存在显著的相互作用（交互作用的P值 = 0.
