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

Yu-Jun Xiong,1 Da-Ming Shao,2 Xing-Yun Zhu,3 Tian Lv4 1Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Department of Rheumatology, The University of Chicago Medical Center, Chicago, IL, The United States of America; 3Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, People’s Republic of China; 4Department of Neurology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang Province, People’s Republic of ChinaCorrespondence: Tian Lv, Department of Neurology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang Province, People’s Republic of China, Email [email protected]: 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.Keywords: CHARLS, hypertension, BMI, remnant cholesterol, mediating effect