Remnant cholesterol associates with hypertension beyond low-density lipoprotein cholesterol among the general US adult population

Front Endocrinol (Lausanne). 2023 Sep 29:14:1260764. doi: 10.3389/fendo.2023.1260764. eCollection 2023.

Abstract

Background: Previous findings have indicated that elevated low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) are associated with hypertension. We aim to explore whether higher RC levels may be associated with hypertension beyond LDL-C in the general US adult population.

Methods: This study included 10,842 adults from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Weighted multivariable logistic regression models were used to estimate the odds ratios (ORs) of hypertension for LDL-C and RC. We also performed analyses examining the association between hypertension and LDL-C vs. RC concordant/discordant groups.

Results: A total of 4,963 (41.54%, weighted) individuals had hypertension. The weighted median levels were LDL-C: 118mg/dL, RC: 20mg/dL. At lower LDL-C clinical cut-point, the proportion of discordantly high RC dramatically increased. After multivariable adjustment, log RC was associated with higher prevalence of hypertension [OR 2.54, 95% confidence interval (CI) 2.17-2.99]. Participants with the highest tertile of RC were more likely to have hypertension (OR 2.18; 95% CI 1.89-2.52) compared with those with the lowest tertile of RC. This association remained marked after including body mass index (BMI), LDL-C, high-density lipoprotein cholesterol (HDL-C) or triglycerides. The association between LDL-C and hypertension was absent after adjusting for BMI, RC or triglycerides. Compared with low LDL-C/low RC group, the discordant low LDL-C/high RC group was associated with hypertension (OR 2.04; 95% CI 1.72-2.42), whereas the high LDL-C/low RC group was not, regardless of BMI, HDL-C or triglycerides. Similar results were observed when examining discordance among different clinical cut-points, except for the cut-point of LDL-C 70 mg/dL and RC 13 mg/dL. To better understand the association, we performed an additional analysis, which showed that among participants with apolipoprotein B < median (92mg/dL), those with discordant RC ≥ median (20mg/dL) had significantly higher odds of having hypertension (OR 1.73; 95% CI 1.38-2.17).

Conclusion: RC was associated with hypertension beyond LDL-C in the general US adult population. This association went beyond increased triglycerides levels, and lipoproteins other than apoB may be involved.

Keywords: apolipoprotein B; dyslipidemia; hypertension; low-density lipoprotein cholesterol; remnant cholesterol.

MeSH terms

  • Adult
  • Apolipoproteins B
  • Cholesterol
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Humans
  • Hyperlipidemias*
  • Hypertension* / epidemiology
  • Nutrition Surveys
  • Triglycerides

Substances

  • Cholesterol, LDL
  • Cholesterol
  • Cholesterol, HDL
  • Triglycerides
  • Apolipoproteins B

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by grant CI2021A00917 and CI2021A00920 from the China Academy of Chinese Medical Sciences Innovation Fund, and grant 82230125 and 82274508 from the National Natural Science Foundation of China. The funders were not involved in the design or conduct of the study; in the collection, analysis, or interpretation of data; and in the preparation, review, or approval of the paper.