Joint Association of Remnant Cholesterol and Body Mass Index with Hypertension: A National Cohort Study in Chinese Adults.

Q: What are the key findings of this study?

Co-occurrence of obesity and high remnant cholesterol increased the risk of incident hypertension compared to non-obese individuals with low remnant cholesterol levels.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=3805). Intervention: Co-occurrence of obesity (BMI ≥28.0 kg/m²) and high remnant cholesterol vs. Non-obesity and lowest remnant cholesterol tertile. Primary outcome: New-onset hypertension (HR 2.18, 95% CI 1.48-3.21, p=<0.001).

Q: What question did this study set out to answer?

To evaluate the individual and joint associations of remnant cholesterol and body mass index with incident hypertension, and quantify mutual mediation effects.

Yujun Xiong; Ди Шао; Xing-Yun Zhu; Tian Lv

doi:10.2147/jmdh.s516335

January 1, 2025Open Access

Joint Association of Remnant Cholesterol and Body Mass Index with Hypertension: A National Cohort Study in Chinese Adults.

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Key result

Obesity plus high remnant cholesterol is linked to ~2.2-fold higher risk of incident hypertension.

HR 2.18
95% CI 1.48-3.21
P<0.001
n=3,805

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Why the study?

The joint impact of remnant cholesterol and body mass index on hypertension risk remains unclear.

Does the combination of elevated remnant cholesterol and obesity increase the risk of incident hypertension in middle-aged and older Chinese adults?

Key Points

To evaluate the individual and joint associations of remnant cholesterol and body mass index with incident hypertension, and quantify mutual mediation effects.
Analyzed 3805 adults aged over 45 years (mean age: 56.97 years; 44.26% male) without baseline hypertension from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020.
Assessed incident hypertension risk using multivariable Cox proportional hazard models adjusting for demographics, lifestyle, and cardiometabolic covariates, alongside restricted cubic splines and mediation analyses.
Over a 9-year follow-up, 590 participants (15.51%) developed incident hypertension.
Compared with non-obesity and the lowest remnant cholesterol tertile, participants with obesity (BMI ≥28.0 kg/m²) and the highest remnant cholesterol tertile had a hazard ratio of 2.18 (95% CI: 1.48–3.21, p < 0.001) in fully adjusted Model 3.
Mediation analysis revealed that remnant cholesterol mediated 7.07% of the association between BMI and hypertension, whereas BMI mediated 29.3% of the relationship between remnant cholesterol and hypertension.

Study Design

Type

Cohort (n=3,805)

Multicenter

Yes

Structured PICO

Does the combination of elevated remnant cholesterol and obesity increase the risk of incident hypertension in middle-aged and older Chinese adults?

P

Population

3,805 middle-aged and older Chinese adults free of baseline hypertension followed for up to 9 years to evaluate the incidence of new-onset hypertension based on body mass index and remnant cholesterol levels.

E

Exposure

Elevated body mass index (obesity, BMI ≥28.0 kg/m²) and high remnant cholesterol (highest tertile, 0.64 < RC ≤ 7.068 mmol/L) as observational exposures

C

Comparator

Non-obesity (BMI < 28.0 kg/m²) and lowest remnant cholesterol tertile (-0.46 ≤ RC ≤ 0.33 mmol/L)

O

Outcome

New-onset hypertension during follow-up, defined by self-reported medical diagnosis, use of antihypertensive medications, or blood pressure over 140/90 mmHg

Main Result

Hazard Ratio: 2.18 (95% CI 1.48–3.21)

p-value: p=<0.001

Elevated remnant cholesterol and body mass index are independently and jointly associated with an increased risk of incident hypertension, with remnant cholesterol partially mediating the relationship between obesity and hypertension.

Limitations

Observational design precludes establishing definitively causal relationships between BMI, remnant cholesterol, and hypertension.
Hypertension and other key covariates were identified based on self-reported physician diagnoses and medication use, which may introduce misclassification and recall bias.
BMI does not fully capture fat distribution or muscle mass compared to alternative metrics like waist circumference.
Generalizability may be limited as the cohort consisted exclusively of middle-aged and older Chinese adults.
Observational design precludes definitive establishment of causal relationships and residual confounding remains a concern
Hypertension identification and other key covariates were self-reported, potentially introducing misclassification and recall bias
BMI does not fully capture body fat distribution or muscle mass
Generalizability is limited to middle-aged and older Chinese populations

Ask about this paper

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Implication

May refine hypertension risk stratification among obese adults; extends mediation data but requires prospective confirmation before clinical use.

Abstract

Background: Hypertension, a major global health concern, is closely associated with obesity and lipid abnormalities. Remnant cholesterol (RC), a triglyceride-rich lipoprotein component, has been linked to cardiovascular diseases, but its joint impact with body mass index (BMI) on hypertension risk remains unclear. Methods: We analyzed data from 3805 participants (mean age: 57 years; 44.3% male) in the China Health and Retirement Longitudinal Study (CHARLS) from 2011-2020. Inclusion criteria were adults aged over 45 years with complete data on blood lipids and BMI. Participants with baseline hypertension or missing covariate data were excluded. Cox proportional hazard models assessed associations, while mediation analysis explored RC's role in BMI-hypertension linkage. Results: Over a 9-year follow-up, 590 participants developed hypertension. Obesity (BMI ≥28.0 kg/m²) and high RC levels were independently associated with hypertension (HR: 2.18; 95% CI: 1.48-3.21 for the highest RC tertile). RC mediated 7.07% of BMI's effect on hypertension, and BMI mediated 29.3% of RC's effect. Conclusion: This study highlights the intertwined roles of BMI and RC in hypertension development. Targeting both risk factors may enhance prevention strategies.

Discussion

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Cite This Study

Xiong et al. (2025) conducted a cohort in Hypertension (n=3,805). Co-occurrence of obesity (BMI ≥28.0 kg/m²) and high remnant cholesterol vs. Non-obesity and lowest remnant cholesterol tertile was evaluated on New-onset hypertension (HR 2.18, 95% CI 1.48-3.21, p=<0.001). Co-occurrence of obesity and high remnant cholesterol increased the risk of incident hypertension compared to non-obese individuals with low remnant cholesterol levels.

synapsesocial.com/papers/6a59710d7502e763718925c1 https://doi.org/10.2147/jmdh.s516335

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Joint Association of Remnant Cholesterol and Body Mass Index with Hypertension: A National Cohort Study in Chinese Adults.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Joint Association of Remnant Cholesterol and Body Mass Index with Hypertension: A National Cohort Study in Chinese Adults.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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