Association between remnant cholesterol level and gout in US adults

Background Gout is a common metabolic condition defined by high levels of uric acid in the blood and is linked to notable comorbidities. Despite extensive research on lipid metabolism and gout, the relationship between levels of remnant cholesterol, a non-traditional lipid marker, and gout remains unexplored. Methods In this cross-sectional analysis, a total of 11,685 adults aged ≥20 years were selected from the National Health and Nutrition Examination Survey datasets spanning 2007 to 2018. To investigate the link between remnant cholesterol level and gout, multivariate logistic regression models were employed, adjusting for demographic, lifestyle, and health-related covariates. Dose–response associations were examined using restricted cubic spline analysis, and subgroup analyses were performed to examine potential effect modifiers. In addition, mediation analyses were conducted to assess whether body mass index and serum uric acid levels partially mediated the observed association. Results Elevated remnant cholesterol levels showed a significant relationship with a higher prevalence of gout (odds ratio = 1.01, 95% confidence interval: 1.01–1.02, per 1-mg/dL increase in remnant cholesterol level). Participants in the top quartile of remnant cholesterol level had 65% greater odds of gout than those in the bottom quartile (odds ratio = 1.65, 95% confidence interval: 1.24–2.19, p for trend <0.001). Restricted cubic spline analysis demonstrated a linear positive relationship between remnant cholesterol level and gout. Subgroup analyses and interaction tests demonstrated the robustness of this association across diverse population subgroups. Further mediation analyses indicated that body mass index and serum uric acid levels mediated for 23% and 40% of the total effect of remnant cholesterol level on gout, respectively. Conclusion This study is the first to reveal a significant positive association between remnant cholesterol and gout in US adults, with body mass index and serum uric acid levels acting as partial mediators of this relationship. These findings highlight the potential value of remnant cholesterol as a novel risk marker for gout.