Long-Term Cumulative Exposure and Variability of Remnant Cholesterol and Risk of Incident Hypertension: A Prospective Cohort Study (2002-2018) Publisher Pubmed



Molavizadeh D ; Cheraghloo N ; Tohidi M ; Taghizadeh K ; Abiri B ; Azizi F ; Hadaegh F
Source: Journal of Clinical Lipidology Published:2025

Abstract

BACKGROUND Prior studies examining the association between remnant cholesterol (RC) and hypertension have employed a snapshot approach, which limits our understanding of its longitudinal effects across an individual’s lifetime. OBJECTIVE To evaluate the association between cumulative exposure to RC and its variability and risk of incident hypertension stage 2 (using the 2025 American College of Cardiology/American Heart Association Guideline) in the general population. METHODS A total of 5852 participants were included in analyses. Cumulative RC, cumulative burden of RC, and exposure duration of high-RC; as well as RC variability (assessed by standard deviation [SD], variability independent of mean [VIM], and average real variability [ARV]), were calculated during the exposure period (2002-2011). Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs. RESULTS During the follow-up period (2011-2018), 1157 participants developed hypertension. In multivariable analyses, a 1-SD increase in both cumulative RC (HR [95% CI]: 1.06 [1.00-1.13]) and cumulative burden of RC (1.08 [1.02-1.15]), as well as greater duration of high-RC exposure (9 vs 0 years: 1.20 [1.00-1.43]; P for trend = .04), were associated with incident hypertension. Regarding RC variability, 1-SD increment of SD (1.12 [1.04-1.21]) and ARV (1.10 [1.03-1.18]) was associated with incident hypertension and corresponding risk increased significantly across the quartiles of SD (Q4 vs Q1: 1.27 [1.03-1.56]; P for trend ≤ .01) and VIM (Q4 vs Q1: 1.24 [1.01-1.54]; P for trend = .01). In subgroup analyses, these associations were more pronounced among normotensive participants. CONCLUSION Maintaining RC at low and stable levels, particularly in individuals with normal blood pressure, may help prevent incident hypertension. Copyright © 2025. Published by Elsevier Inc.