Association Between Remnant Cholesterol and Endometriosis Findings from NHANES 1999–2006

Luyang Su, Xiaona Wang, Junqin Zhang, Ren Xu, Yanan Ren, Shaoqing Wang
2025 · W7117856209
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study analyzed NHANES data and found that elevated remnant cholesterol levels are significantly associated with a higher prevalence of endometriosis in women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

Using cross-sectional NHANES 1999–2006 data, the study analyzed 1,979 women aged 20–54 to test whether remnant cholesterol (RC), calculated from fasting lipids, was associated with self-reported endometriosis diagnosed by a health professional. Weighted logistic regression models (unadjusted, partially adjusted, and fully adjusted for demographics and cardiometabolic variables including smoking, BMI, hypertension, diabetes, HDL-C, LDL-C, and contraceptive pill use) found that higher RC was significantly associated with greater endometriosis prevalence, with each 1 mg/dL above the RC mean corresponding to about a 2.2–2.3% higher odds across models. The highest RC tertile showed higher prevalence versus the lowest tertile, but the tertile comparison/trend was not statistically significant (p for trend = 0.077), and smoothing suggested a linear dose-response without threshold or saturation. The authors explicitly note limitations including the self-reported outcome, modest number of cases, and the inability of a cross-sectional design to support causal inference, leaving potential selection bias, reverse causation, and unmeasured confounding. This paper is centrally about endometriosis—specifically the association between elevated remnant cholesterol levels and endometriosis prevalence in a representative US sample.

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Abstract

Luyang Su,1,* Xiaona Wang,2,* Junqin Zhang,2,* Ren Xu,3,* Yanan Ren,2,* Shaoqing Wang4,* 1Physical Examination Center, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China; 2Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China; 3Quality Management Department, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China; 4Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shaoqing Wang, Email [email protected]: Endometriosis is a chronic gynecological disorder causing significant morbidity and health burden. Recent evidence suggests that lipid metabolism, particularly remnant cholesterol (RC), may be involved in its development. RC—the cholesterol content of triglyceride-rich lipoproteins (TGRLs), including chylomicrons, very low-density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL). Elevated RC is closely associated with arteriosclerosis and increased cardiovascular disease incidence, making it a valuable biomarker for assessing cardiovascular health. This study explores the association between RC levels and endometriosis prevalence in a representative sample of women.Methods: Using cross-sectional data from NHANES (1999– 2006), we analyzed 1,979 women aged 20– 54 years. Weighted logistic regression models were applied to assess the relationship between RC and endometriosis. Three models were used: unadjusted (Model 1), adjusted for age, ethnicity, education, and marital status (Model 2), and fully adjusted for additional variables (Model 3). Subgroup analyses and smoothing curve fitting were also performed.Results: Elevated RC levels were significantly associated with higher endometriosis prevalence across all models. Each 1 mg/dL above the mean level of RC was linked to a 2.3% higher incidence of endometriosis (Model 1: OR 1.023, 95% CI 1.009– 1.036, p = 0.001; Model 2: OR 1.022, p = 0.004; Model 3: OR 1.023, p = 0.022). Individuals in the highest RC tertile had a higher incidence of endometriosis compared to the lowest tertile (OR 1.833, p for trend = 0.077). A linear dose-response relationship was identified, with no threshold or saturation effects.Conclusion: The study indicates a strong correlation between elevated RC levels and increased endometriosis incidence, highlighting the potential role of lipid metabolism in endometriosis development.Keywords: remnant cholesterol, endometriosis, lipid metabolism, inflammation, NHANES

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