Nutrition, Metabolism, and Cardiovascular Diseases · Jul 8, 2026

Remnant cholesterol and incident metabolic syndrome: evidence from a prospective cohort with emphasis on individuals with normal triglyceride levels

By Tang S, Tao Y

BACKGROUND AND AIMS: Few longitudinal studies have examined remnant cholesterol (RC) in relation to incident metabolic syndrome (MetS), particularly among individuals with normal triglycerides (TG). We investigated the association of RC with incident MetS and its components. METHODS AND RESULTS: This study analyzed 3011 CHARLS participants free of MetS at baseline. Multivariable modified Poisson regression estimated the association between baseline RC and incident MetS and its individual components over a 4-year follow-up. Incremental predictive value was assessed by adding RC to a TG-inclusive baseline model using AUC, continuous NRI, and IDI. During follow-up, baseline RC was associated with incident MetS (RR per 1-SD: 1.28, 95% CI: 1.22-1.35). Compared with the lowest quartile, participants in the highest RC quartile had a 2.09-fold higher risk of MetS (95% CI: 1.65-2.65). The association appeared stronger among participants with normal TG levels (<150 mg/dL) (RR per 1-SD: 1.39, 95% CI: 1.21-1.59). RC was associated with incident hypertension, central obesity, and hypertriglyceridemia, but not hyperglycemia or low HDL-C. After baseline TG was incorporated into the prediction model, adding RC did not improve global discrimination or reclassification in the overall population. However, phenotype analysis based on absolute thresholds identified a normal-TG/high-RC subgroup comprising 6.6% of participants, which had a 50% higher risk of incident MetS. CONCLUSIONS: Elevated RC was associated with incident MetS and may support refined risk stratification among middle-aged and older adults with normal triglyceride levels.

doi.org/10.1016/j.numecd.2026.104862PubMed 42463336Biomarkers