Association between remnant cholesterol and peripheral artery disease from multiple perspectives

Remnant cholesterol (RC) has emerged as an atherogenic lipid fraction that may be associated with residual cardiovascular risk beyond low density lipoprotein cholesterol (LDL-C). However, its role in peripheral artery disease (PAD) has not been fully characterized.

We analyzed data from National Health and Nutrition Examination Survey (NHANES) 1999-2004 including adults aged ≥40 years with available ankle-brachial index (ABI), lipid measurements and relevant covariates. Weighted logistic regression models were used to examine the association between RC and PAD. Discordance between RC and LDL-C was assessed using clinical equivalence approach to evaluate its association with PAD. The remnant cholesterol inflammatory index (RCII) and relevant mediation analyses were used to assess the role of inflammation.

Among 3111 participants, higher RC levels were independently associated with a higher prevalence of PAD. In discordance analyses, discordantly low RC was generally associated with a lower prevalence of PAD, whereas discordantly high RC demonstrated attenuated associations after full adjustment. Higher RCII was associated with increased PAD risk, and C-reactive protein (CRP) partially mediated the association between RC and PAD.

Higher RC is associated with an increased prevalence of PAD and may provide complementary risk information beyond LDL-C. Systemic inflammation partially mediates this association, supporting a potential relevance of RC in PAD risk stratification.