High atherogenic index of plasma increased the risk of new-onset hypertension

BACKGROUND AND AIM: The atherogenic index of plasma (AIP), calculated as log10 (triglyceride/high-density lipoprotein cholesterol, TG/HDL-C), has been proposed as a reliable marker for evaluating lipid-related atherosclerotic risk. However, the association between AIP and new-onset hypertension (HTN) remains controversial. This study aimed to investigate the relationship between AIP and new-onset HTN and to explore the potential mediating role of body mass index (BMI). METHODS AND RESULTS: This prospective cohort study included adult participants without HTN at baseline who were enrolled from a large community-based health screening program between 2014 and 2023. Baseline clinical characteristics, anthropometric parameters, and biochemical indices were collected. Restricted cubic spline (RCS) analysis was used to determine the inflection point of AIP for grouping participants into low- and high-AIP categories. Propensity score matching (PSM) was applied to balance baseline confounders between groups. The cumulative incidence of HTN was compared using cumulative risk curves and log-rank tests. Multivariate Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Mediation analysis was performed to assess whether BMI mediated the relationship between AIP and new-onset HTN. The results showed participants with higher baseline or cumulative AIP values had a significantly higher risk of developing HTN (log-rank p < 0.001). After multivariable adjustment, individuals in the high-AIP group exhibited an elevated risk of new-onset HTN (HR = 1.42, 95 % CI 1.25-1.61, p < 0.001) compared with those in the low-AIP group. BMI partially mediated the association between AIP and HTN, accounting for approximately 5.76 % of the total effect (p < 0.001). CONCLUSIONS: A high AIP increased the risk of new HTN. BMI potentially mediated the association between the AIP and new-onset HTN.