Association of Radiation Exposure and Blood Lipid Derived Indices with Hypertension Risk in Radiation Workers

Background This study aimed to investigate the associations of occupational radiation exposure, serum lipids and their derived indices with hypertension risk among radiation workers, and to analyze the mediating effect and predictive value of lipid profiles in the relationship between radiation exposure and hypertension, so as to provide evidence for the prevention and control of hypertension in this population. Methods A cross-sectional study (2,548 subjects) and a retrospective cohort study (484 subjects) were conducted among radiation workers who underwent physical examinations at a medical center in Shijiazhuang from October 2021 to March 2025. In the cross-sectional study, multivariate Logistic regression, restricted cubic spline (RCS) and mediation analysis were used to explore the association between radiation exposure and hypertension, as well as the mediating role of lipid parameters. In the cohort study, Cox proportional hazards regression, Kaplan‑Meier curve, receiver operating characteristic (ROC) curve, stratified analysis and sensitivity analysis were applied to evaluate the association and predictive performance of baseline lipid indices for incident hypertension. Results The cross-sectional analysis showed that, after adjustment for confounders, radiation working years, high working‑year group and industrial radiation exposure were risk factors for hypertension (all P  < 0.05); high‑density lipoprotein cholesterol (HDL‑C) was a protective factor, while elevated total cholesterol (TC), triglyceride (TG), low‑density lipoprotein cholesterol (LDL‑C), fasting blood glucose/HDL‑C (FBG/HDL‑C), TC/HDL‑C and non‑HDL‑C/HDL‑C ratio (NHHR) were risk factors. Mediation analysis indicated that TC, TG and LDL‑C might mediate the positive association between long working years and hypertension, whereas HDL‑C mediated the inverse association of working years and industrial radiation with hypertension. The cohort analysis revealed that elevated baseline TG, FBG/HDL‑C, TC/HDL‑C and NHHR increased the risk of incident hypertension, while elevated HDL‑C decreased such risk; FBG/HDL‑C and TC/HDL‑C showed the best predictive performance; these associations were more prominent in males and overweight individuals. Conclusions In conclusion, prolonged radiation working years and industrial radiation exposure are associated with an increased risk of hypertension in radiation workers, and lipid profiles may play a mediating role. FBG/HDL‑C, TC/HDL‑C and NHHR are superior to conventional lipid indices in predicting hypertension. Male and overweight radiation workers are key targets for hypertension prevention and control.