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. 2024 Nov 20;23(1):385.
doi: 10.1186/s12944-024-02372-x.

The mediating role of inflammation in the association between cotinine levels and remnant cholesterol: a cross-sectional study

Tianjie Lai #  1 , Zhihao Su #  1   2 , Gaoqiang Tian  1 , Jingui Sun  1 , Konghe Hu  3
Affiliations

The mediating role of inflammation in the association between cotinine levels and remnant cholesterol: a cross-sectional study

Tianjie Lai et al. Lipids Health Dis. .

Abstract

Background: Remnant Cholesterol (RC) has emerged as a significant risk factor for cardiovascular disease. However, the factors influencing RC levels remain incompletely understood. This research investigates smoking-a major modifiable risk factor-to elucidate its impact on RC levels and examine the mediating role of inflammation in this relationship.

Methods: Using NHANES data from 1999 to 2018, this study analyzed the association between serum cotinine levels (a biomarker of smoking intensity) and RC in 8,829 participants aged 20 years and older. Through complex sampling design and adjustment for multiple covariables, we examined both linear and nonlinear relationships using linear regression models, restricted cubic splines (RCS), and subgroup analyses. Additionally, mediation analyses evaluated the role of inflammatory markers-neutrophils (NEU), monocytes (MON), lymphocytes (LYM), and platelets (PLT)-in this association.

Results: The high cotinine exposure group demonstrated significantly elevated RC levels (β = 2.256, 95% CI: 1.401-3.112, p < 0.001) compared to the no/minimal exposure group. This positive association was particularly pronounced in females (p for interaction < 0.05). Restricted cubic spline analysis demonstrated a nonlinear, N-shaped relationship (p for nonlinearity < 0.05), with RC levels reaching their peak at cotinine concentrations of approximately 172 ng/mL. In the mediation analysis, inflammatory markers showed significant mediating effects: NEU (28%), LYM (14.1%), PLT (9.5%), and MON (6.9%) of the total effect.

Conclusion: A significant positive association exists between cotinine and RC levels, moderated by sex. Inflammatory markers, particularly NEU, partially mediate this association.

Keywords: Biomarker; Cardiovascular disease; Cotinine; cross-sectional study; NHANES; Remnant cholesterol (RC).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This research complied with the Helsinki Declaration and used NHANES data which has undergone ethical review by NCHS. As a secondary analysis of this approved dataset following STROBE guidelines, no additional ethical approval was required. Consent for publication: Written informed consent for publication was obtained from all participants. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the participants’ selection
Fig. 2
Fig. 2
Trend tests of association between cotinine and RC
Fig. 3
Fig. 3
RCS analysis of the association between cotinine and RC
Fig. 4
Fig. 4
The mediating role of inflammatory biomarkers in the association between cotinine and RC
See this image and copyright information in PMC

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