Association between remnant cholesterol and abdominal aortic calcification: Exploratory mediation analysis involving diabetes and insulin resistance in the general population
Restricted accessResearch articleFirst published online 2026
Association between remnant cholesterol and abdominal aortic calcification: Exploratory mediation analysis involving diabetes and insulin resistance in the general population
Remnant cholesterol (RC) is a non-traditional lipid parameter that reflects residual risk of cardiovascular disease. The purpose of the present study was to explore the relationship between RC and abdominal aortic calcification (AAC) in the U.S. general population. Data were obtained from the 2013–2014 National Health and Nutrition Examination survey. The severity of AAC was assessed using the Kauppila scoring system. Multivariable linear and logistic regression analyses were used to assess the associations of RC with AAC score and severe AAC (score ≥ 5), respectively. In addition, subgroup analyses and mediated effects analysis were performed. A total of 1062 participants were enrolled for analysis. The results of regression analysis demonstrated a positive relationship between RC and both AAC score and severe AAC (β = 0.23, 95% CI 0.04–0.42, p = 0.017; OR = 1.44, 95% CI 1.12–1.85, p = 0.004, per 1-SD increase). Compared with the lowest RC tertile, the AAC score of tertile 3 significantly increased 0.66-unit (β = 0.66, 95% CI 0.19–1.12, p = 0.006), and the risk of severe AAC increased by 165% (OR = 2.65, 95% CI 1.35–5.18, p = 0.005). The results of subgroup analyses showed that no statistically significant interaction across variables. Furthermore, mediation analysis revealed that type 2 diabetes mellitus (T2DM) accounted for 6.76% of the association between RC and AAC, whereas insulin resistance (HOMA-IR) explained 23.4% of this relationship, both showing significant indirect effects. RC was positively associated with AAC score, and higher RC levels were related to higher risk of severe AAC, with both T2DM and insulin resistance acting as mediators.
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