Endostatin made the lipedema headlines when a study published July 2026 found that endostatin levels may be a differentiating factor in lipedema when compared to BMI-matched controls without lipedema. Endostatin is a collagen-derived peptide and potent inhibitor of angiogenesis (new blood vessel formation). This study showed statistically significant lower levels of endostatin in the lipedema cohort. [1]
Research by Al-Ghadban et al describes the altered vascularization seen in lipedema including aberrant angiogenesis and endothelial dysfunction which translates to symptoms like spider veins, venous insufficiency, and easy bruising.[2] With less endostatin, you essentially lose some of the brakes with vascular formation.
Another relevant mechanism of endostatin is that it inhibits adipogenesis or fat formation (new fat cells need new blood vessels), so the lower endostatin could very well be a factor in the increased fat formation seen in lipedema.[3] Furthermore, it has anti-fibrotic properties so some protection against fibrosis would also be lost with lower endostatin.[4]
LDL and Endostatin
This study by Kempa et al also showed a correlation between higher LDL cholesterol levels and lower endostatin levels in lipedema. This checks out with relevant pathophysiology and other studies on LDL and lipedema. Nankam et al. found that despite better glucose control and higher adiponectin, women with lipedema have significantly higher total cholesterol and LDL cholesterol than BMI-matched controls.[5] This is important not only for localized lipedema tissue, but in its systemic vascular effects. A loss of endostatin’s anti-fibrotic and anti-atherosclerotic effects combined with higher LDL is worth considering in further research and on an individual cardiac risk-reduction level.
It’s important to note that correlation is not causation, and though endostatin is not a readily available lab test in the clinical setting, many other cardiovascular risk markers are, including of course a basic lipid panel with LDL cholesterol as well as more advanced but important markers like Apo B, lipoprotein (a), and imaging like coronary calcium scores and CIMT.
Sources
1. Kempa S, Weiss TS, Tews HC, et al. Reduced serum endostatin in premenopausal women with lipedema suggests altered vascular homeostasis. Diseases. 2026;14(7):168. doi:10.3390/diseases14070251
2. Al-Ghadban S, Guo Y, Juskiewicz ZJ, et al. Vascular changes and their implications in lipedema. Front Cell Dev Biol. 2026;14:1819443. doi:10.3389/fcell.2026.1819443
3. Wang H, Chen Y, Lu XA, et al. Endostatin prevents dietary-induced obesity by inhibiting adipogenesis and angiogenesis. Diabetes. 2015;64(7):2442-2456. doi:10.2337/db14-0528
4. Anakha J, Prasad YR, Pande AH. Endostatin in disease modulation: from cancer to beyond. Vascul Pharmacol. 2025;158:107459. doi:10.1016/j.vph.2024.107459
5. Nankam PAN, Cornely M, Klöting N, Blüher M. Is subcutaneous adipose tissue expansion in people living with lipedema healthier and reflected by circulating parameters? Front Endocrinol (Lausanne). 2022;13:1000094. doi:10.3389/fendo.2022.1000094
