Animal experiments suggest that bisphenol A (BPA) could potentially induce lipid abnormalities. However, whether BPA exposure associates with altered lipid metabolism in humans has not been fully elucidated. We thus comprehensively investigated the relationship of BPA exposure and its change with lipid profile and development of incident dyslipidemia among Chinese adults. We initially included 1872 participants aged 40 years or older who were free of dyslipidemia at baseline in 2009, and followed them for 4 years. Urinary BPA and serum lipids including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were determined at baseline and follow-up. Linear mixed models were used for repeated measures analyses and linear and logistic regression models were used to evaluate longitudinal changes in lipid profile and risk of incident dyslipidemia. In repeated measures analyses, per doubling of urinary BPA concentrations was associated with higher serum levels of LDL-C, non-HDL-C, TC to HDL-C ratio, and lower levels of HDL-C and TG. In longitudinal change analyses, participants with high BPA at both baseline and follow-up showed an additional 2.94% increase in LDL-C (95% CI: 0.02%, 5.95%) and 6.12% increase in TG (95% CI: 0.74%, 11.8%), as compared with those who maintained low BPA. Furthermore, participants with sustained high BPA at two time points had increased odds of developing hyper-LDL cholesterolemia (odds ratio = 1.93, 95% CI: 1.02, 3.66). Our results suggested that high BPA exposure, especially maintained a long time period apart, was associated with deterioration of lipid profiles among middle-aged and elderly adults, supporting a detrimental role of BPA in lipid metabolism.