Favorable lipid profiles and elevated HDL-C are associated with uterine fibroid volume: a case-control study in an Indian cohort

Uterine fibroids are the most prevalent benign neoplasms in reproductive-aged women. While linked to metabolic syndrome and dyslipidemia in Western populations, their metabolic underpinnings in leaner, non-Western cohorts remain under-researched. The present study was undertaken to investigate the association of serum lipid components, anthropometric parameters, and fibroid volume using archived clinical and laboratory records in an Indian case-control setting. This retrospective hospital-based case-control study analyzed patient records from January 2022 to December 2024. Data were extracted for 116 premenopausal women with ultrasound-confirmed fibroids and 116 age-matched symptomatic controls (presenting with chronic cervicitis or bacterial vaginosis, without fibroids) (Total N = 232, ages 30–50). Exclusion criteria applied during record abstraction included documented hypertension, diabetes, thyroid disease, and hormonal therapy. Routine baseline fasting lipid profile (TC, LDL-C, HDL-C, and TG), hemoglobin (Hb), and inflammatory markers (TLC, ESR) were retrieved. Fibroid volume was calculated using the prolate ellipsoid formula (0.523xD1 x D2 x D3). In multi-lesional cases, the largest fibroid volume (LFV) was analyzed. Data were analyzed using log transformation for skewed volume data and multivariate linear regression. Patients were younger than controls (37.3 ± 5.9 vs. 39.8 ± 5.2 years; p = 0.007) and had a higher documented prevalence of spontaneous abortions (48% vs. 14%; p < 0.001). Hb was significantly lower in cases (9.8 ± 2.5 vs. 10.7 ± 1.9 g/dL, p < 0.001). Total cholesterol (153.0 ± 32.9 vs. 179.6 ± 33.1 mg/dL, p < 0.001) and atherogenic index (2.8 ± 1.9 vs. 3.4 ± 1.7, p < 0.001) were significantly lower in fibroid cases. In contrast, HDL-C was significantly higher in cases (46.9 ± 5.3 vs. 39.6 ± 7.3 mg/dL, p < 0.001). LFV was significantly and directly correlated with HDL-C levels (r = 0.671, p < 0.001). In multivariate regression adjusted for continuous age, BMI, parity, and Hb, HDL-C remained a robust independent predictor of log-transformed LFV (standardized β = 0.612, unstandardized B = 0.37, 95%CI: 0.28 to 0.46, p < 0.001). No significant differences were observed in BMI, TG, LDL-C, and inflammatory markers. In this lean Indian cohort, elevated HDL-C and lower total cholesterol show a significant statistical association with uterine fibroid volume. Our empirical findings show a significant link between lipid levels and tumor volume; however, due to the retrospective nature of record abstraction, potential selection bias from a symptomatic control group, and the absence of direct hormone assays in routine records, the underlying mechanisms should be interpreted with caution.