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Exploring the relationship between residual cholesterol, body mass index, and hypertension risk: a national cohort
Tian-Qi Teng1,2, Jing Liu3, Meng-Meng Wang1,2
1Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
Insights
Residual cholesterol (RC) may increase hypertension risk, with body mass index (BMI) acting as a key mediator. Managing metabolic risk factors like RC and BMI is crucial for preventing chronic diseases.
Area of Science:
- Cardiovascular Disease Epidemiology
- Metabolic Syndrome Research
- Public Health & Chronic Disease Management
Background:
- Emerging evidence suggests a correlation between residual cholesterol (RC) and hypertension.
- The precise mechanisms linking RC to hypertension remain incompletely understood.
- Investigating modifiable factors such as RC is vital for effective chronic disease management strategies.
Purpose of the Study:
- To examine the relationship between residual cholesterol (RC) and the incidence of hypertension.
- To investigate the mediating role of body mass index (BMI) in the association between RC and hypertension.
- To analyze the long-term effects of RC and BMI on hypertension development using longitudinal data.
Main Methods:
- Utilized data from 1,788 participants (aged ≥45) in the China Health and Retirement Longitudinal Study (CHARLS) from 2011-2020.
- Treated baseline RC as exposure, 2013 BMI as mediator, and incident hypertension (2015-2020) as outcome, excluding individuals with baseline BMI ≥24 kg/m² or prior hypertension diagnosis.
- Employed mediation analysis to assess the indirect effect of RC on hypertension via BMI, with cross-sectional data validation.
Main Results:
- A 1 mmol/L increase in RC correlated with a 4% higher risk of overweight/obesity (OR=1.04) and a 30% increased risk of hypertension (HR=1.3).
- Elevated BMI in 2013 significantly predicted incident hypertension (OR=1.07).
- BMI-2013 mediated 11.8% of the total effect between RC and hypertension (indirect effect β=0.008, p=0.02).
Conclusions:
- Residual cholesterol (RC) may be a contributing factor to hypertension development.
- Body mass index (BMI) appears to play a significant mediating role in the RC-hypertension pathway.
- Controlling metabolic risk factors, including RC and BMI, is essential for mitigating the burden of hypertension and related chronic diseases.
Background:
Recent studies suggest a link between residual cholesterol (RC) and hypertension, but the mechanisms remain unclear. Exploring modifiable factors like RC may contribute to chronic disease management.
Methods:
A total of 1,788 individuals aged 45 years or older were selected from the China Health and Retirement Longitudinal Study (CHARLS), which was conducted from 2011 to 2020. Participants with a baseline BMI ≥ 24 kg/m² or diagnosis of hypertension in 2013 or earlier were excluded. Here, baseline RC levels were treated as the exposure factor, BMI from the 2013 follow-up as the mediator, and incident hypertension from the 2015-2020 follow-up as the outcome variable. This study examined the effect of RC and BMI on hypertension by focusing on the role of BMI in the underlying mechanisms. Additionally, cross-sectional data from the 2011 CHARLS were included to validate the stability of the mediating relationships.
Results:
After a two-year follow-up (2013), 186 participants (10.4%) developed overweight or obesity (BMI ≥ 24 kg/m²). Within a median follow-up of five years (2015-2020), 24% (430 individuals) experienced the onset of hypertension. RC levels rising by 1 mmol/L were tied to a 4% increase in the risk of overweight/obesity (OR = 1.04, 95% CI: 1.01-1.08). Similarly, an increase of 1 mmol/L in RC was linked to a 30% increased risk of developing hypertension (HR = 1.3, 95% CI: 1.1-1.55). BMI-2013 was significantly associated with incident hypertension (OR = 1.07, 95% CI: 1.03-1.11). These findings remained stable after adjusting for covariates. BMI-2013 was identified as a key mediator in the connection between RC and hypertension, with an indirect effect of β = 0.008 (95% CI: 0.003-0.01, p = 0.02) and a total effect of β = 0.064 (95% CI: 0.017-0.110, p < 0.001), accounting for 11.8% of the total effect (P = 0.02). Sensitivity analysis of the cross-sectional data suggested that the results were stable.
Conclusion:
RC may contribute to hypertension development, with BMI potentially acting as a mediator. These findings highlight the importance of metabolic risk control in reducing the burden of chronic diseases.
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