Patient data• Low serum levels of cholesterol, LDL-C, HDL-C (lower in MSA-C patients), and TG are associated with both, MSA-C and MSA-P, but have no effect on disease progressionIn vivo studies• Transcriptome analysis of striatal astrocytes of a MSA mouse model revealed a downregulation of genes involved in lipid metabolismGenetic risk factors• inconclusive• weak connection to APOE ε4. This evidence concerns the gene APOE and multiple system atrophy, cerebellar type.