Background: Major depressive disorder (MDD) patients often have different clinical manifestations at different age of onset. Anxiety symptoms are frequently seen in patients with MDD, and dyslipidemia is also prevalent in these populations. There is limited reporting on the frequency of anxiety symptoms and their associations with clinical factors in patients with abnormal lipid metabolism who have MDD. Methods: Our study included 1718 first-episode untreated MDD outpatients aged 18-60 years, 1408 of whom had dyslipidemia. We collected basic information, clinically relevant data, and biochemical indicators from these patients. Anxiety, depression and psychiatric symptoms were evaluated by Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Positive and Negative Syndrome Scale (PANSS) positive subscale, respectively. Results: Anxiety symptoms were found in 57.8% of depressed outpatients with dyslipidemia, a rate significantly higher than in MDD patients with normal lipid levels. No statistical difference was observed in the prevalence of anxiety symptoms between the early adulthood onset (EAO) group and mid-adulthood onset (MAO) group. Anxiety symptoms were significantly correlated with both HAMD and PANSS scores, regardless of the age of onset. Thyroid-stimulating hormone (TSH), total cholesterol (TC) levels and suicide attempts were independently associated with anxiety symptoms in the EAO group, whereas fasting blood glucose (FBG) was independently related to anxiety symptoms in the MAO group. Conclusions: Our research findings indicated that the age of MDD onset in patients with dyslipidemia did not impact the presence of anxiety symptom. The clinical factors linked to anxiety symptoms varied between the EAO and MAO groups, potentially aiding in the prediction of anxiety symptoms in the specific population.