To summarize the present evidence for an association between high-density lipoprotein (HDL) or low-density lipoprotein (LDL) cholesterol and abdominal aortic aneurysm (AAA) presence, we performed a systematic review and meta-analysis of case-control studies that compared serum HDL or LDL cholesterol between patients with AAA and control subjects. MEDLINE and EMBASE databases were searched to identify all case-control studies that compared serum HDL or LDL cholesterol between patients with AAA and control subjects. For each study, data regarding serum HDL or LDL cholesterol in both the AAA and control groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted average of logarithmic MDs in both fixed- and random-effects models. Our search identified 8 eligible studies including 812 patients with AAA and 8 267 control subjects. Pooled analysis demonstrated significantly lower serum HDL cholesterol (MD, -0.15 mmol/L; 95% CI, -0.24 to -0.07 mmol/L; P=0.0006) and significantly higher serum LDL cholesterol (MD, 0.25 mmol/L; 95% CI, 0.08 to 0.42 mmol/L; P=0.004) in the AAA group than those in the control group in random-effect models. There was significant study heterogeneity of results but no evidence of significant publication bias. Several sensitivity analyses did not substantively alter the overall result of our analysis. We found that, based on a systematic review and meta-analysis, serum HDL cholesterol is likely lower and serum LDL cholesterol is likely higher in patients with AAA than control subjects. Lower serum HDL cholesterol and higher serum LDL cholesterol may be associated with AAA presence.