Remnant cholesterol is a risk factor for metabolic syndrome and cardiovascular disease: a cross-sectional study

Background: Epidemiologic evidence suggested that remnant cholesterol (RC) is associated with the occurrence of cardiovascular disease (CVD). In recent years, RC has been connected with different types of cardiometabolic disorders. We aim to clarify the relationship among RC, metabolic syndrome (MetS) and subsequent CVD. Methods: We enrolled 7471 individuals into our study from China Health and Nutrition Survey in 2009 and followed participants till 2015. RC was calculated as total cholesterol minus low-density lipoprotein cholesterol minus high-density lipoprotein cholesterol. CVD was defined as myocardial infarction and stroke. Multivariate logistic regression models were used to evaluate the association between RC and MetS as well as CVD. The correlation between RC and MetS or its components were analyzed. We further investigated whether the association between RC and CVD was mediated by MetS. Results: Of all subjects, 24.73% were diagnosed with MetS and 3.58% developed CVD. Multivariate logistic regression analysis elucidated that the risk of MetS increased with RC tertiles and was elevated after adjusting all the confounder factors, (odds ratio: 3.50, 95% confidence interval: 3.22-3.80, P for trend <0.001). Meanwhile, we found that RC level is associated with the prevalence of all the components of MetS. Significant indirect effects of RC between MetS and CVD were found, with the index mediated at 60.90% of the association. Conclusions: : Our study provides the evidence that RC level is independently associated with the prevalence of MetS and each component of MetS. MetS partially mediated the association between RC level and CVD risk.