Abstract
The association between remnant cholesterol (RC) and the risk of developing hypertension remains poorly elucidated. We analyzed China Health and Retirement Longitudinal Study data (CHARLS, 2011-2020). RC was categorized into baseline RC, cumulative RC, and RC change. In Cohort 1 (n = 7474), baseline RC was measured at Wave 1, with incident hypertension identified during Waves 2-5. In Cohort 2 (n = 3956), cumulative RC was calculated using Waves 1 and 3 data, with hypertension assessed during Waves 4-5. Participants were divided into quartiles. Logistic regression was used to assess the association between RC and hypertension. Restricted cubic splines explored non-linear relationships. During follow-up, 2366 (31.7%) and 805 (20.3%) hypertension cases occurred in Cohorts 1 and 2, respectively. A non-linear association was found between baseline RC and hypertension, with an inflection point at 1.16 mmol/L. The highest RC quartile showed increased hypertension risk, with adjusted odds ratios (OR) of 1.52 (p < 0.001) for baseline RC and 1.39 (p = 0.004) for cumulative RC. RC change suggested potential increased risk, though not statistically significant. BMI and HbA1c partially mediated the RC-hypertension relationship, accounting for 36.94 and 7.2% of the total effect, respectively. These findings indicate that elevated baseline and cumulative RC levels are associated with an increased risk of new-onset hypertension in middle-aged and older adults, and that baseline RC levels and hypertension are non-linearly related, with an inflection point of 1.16 mmol/L. Additionally, this study found that BMI and HbA1c mediated the association between RC and incident hypertension.