The interaction between uric acid and high-density lipoprotein cholesterol on the prognosis of patients with acute myocardial infarction

The association between serum uric acid to high density lipoprotein ratio and cardiometabolic-related risk in adults with obesity

INTRODUCTION

The uric acid (UA) to high density lipoproteins (HDL) ratio (UHR) has recently emerged as a new effective biomarker for inflammation and cardiometabolic diseases. However, the relationship between UHR and the metabolic syndrome and its components and other cardiometabolic parameters in individuals with obesity remains to be further investigated.

AIM

To evaluate UHR levels in participants with obesity, as well correlation of UHR with other cardiometabolic risk factors. Moreover, the predictive value of UHR for insulin resistance, metabolic syndrome and visceral adiposity (estimated by using waist circumference) was evaluated, also with respect to UHR components (UA and HDL alone).

METHODS

Participants were enrolled from the Center of Obesity and Work, Occupational Health Unit of Clinica del Lavoro "L. Devoto", Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan (Italy) and divided into two groups according to body mass index (BMI) values; controls (when BMI < 30 kg/m2) and participants with obesity (when BMI ≥ 30 kg/m2).

RESULTS

A total of 1743 (1268 females, mean age 52 ± 14 years) was enrolled in the study. Multiple logistic regression analysis indicated a significant association between obesity and UHR (odds ratio (95% confidence intervals) p value; 1.1 (1-1.1) < 0.01) after adjustment for different biomarkers of cardiometabolic risk. The area under the ROC curve (AUC) of UHR was significantly larger compared with the use of HDL or UA alone for insulin resistance (0.73, 0.3 and 0.67, respectively), metabolic syndrome (0.77, 0.26 and 0.69, respectively) and waist circumference (0.65, 0.37 and 0.62, respectively).

CONCLUSION

Elevated UHR, better than UA or HDL alone, demonstrates a significant correlation with obesity and cardiometabolic parameters, so it could be used as a potential indicator of cardiometabolic risk in this clinical setting.

Association Between the Uric Acid to High-Density Lipoprotein Cholesterol Ratio and Residual Risk for Coronary Artery Disease

Despite advances in anti-atherosclerotic therapies, residual risk persists in coronary artery disease (CAD). The uric acid to high-density lipoprotein cholesterol ratio (UHR), a metabolic-inflammatory marker, may predict residual risk, but its association with plaque progression remains unexplored. This study investigates the impact of UHR on atherosclerotic plaque burden in CAD patients after treatment. In this prospective cohort study, 118 patients with newly diagnosed CAD undergoing percutaneous coronary intervention were stratified into quartiles by baseline UHR. Intravascular ultrasound assessed plaque burden and characteristics at baseline and 12-month follow-up. Logistic regression and restricted cubic spline models evaluated associations between UHR and plaque progression, adjusting for cardiovascular risk factors. At baseline, the highest UHR quartile (UHR-4) exhibited higher rates of plaque rupture (19.6% vs. 0-8.7%, P = 0.002) and microchannels (56.5% vs. 33.3-55.3%, P = 0.031) compared to lower quartiles. Baseline percent atheroma volume (PAV) was greater in UHR-4 (52.73% vs. 51.04-52.09%, P = 0.006). At follow-up, UHR-4 had a 3.2-fold increased risk of plaque burden > 70% (adjusted RR 3.237, 95% CI 1.156-9.063, P = 0.025), with a linear UHR-plaque burden relationship (P = 0.015). No associations were observed between UHR and minimal lumen area or positive remodeling. Elevated UHR is independently associated with high atherosclerotic plaque burden (> 70%) in CAD patients under guideline-directed therapy after adjusting for traditional risk factors. UHR may serve as a complementary biomarker to existing risk scores, guiding targeted therapies to mitigate plaque vulnerability.

Association between the uric acid-to-HDL-cholesterol ratio (UHR) and the risk of cardiovascular disease and dyslipidemia: a population-based study

BACKGROUND AND AIMS

The uric acid-to-HDL-cholesterol ratio (UHR), a novel marker of metabolism and inflammation, has been investigated in various diseases. However, its potential associations with the incidence of cardiovascular disease (CVD) and dyslipidemia remain unclear. This study aimed to examine the relationships between the UHR and the incidence of CVD and dyslipidemia. The primary objective was to evaluate the role of the UHR in predicting CVD and dyslipidemia, whereas the secondary objective was to analyze the predictive effects of the UHR in different subgroups.

METHODS

We conducted a cross-sectional analysis using data from the 2001-2018 National Health and Nutrition Examination Survey (NHANES), which included 6,370 adults aged 18-80 years. Weighted binary logistic regression and subgroup analyses were performed to evaluate the independent associations between the UHR and the risk of various cardiovascular conditions, including overall CVD, congestive heart failure, myocardial infarction, angina, coronary heart disease, and dyslipidemia. To investigate potential nonlinear relationships between the UHR and these outcomes, restricted cubic spline modeling was applied to further elucidate the associations.

RESULTS

Among the 6,370 participants included in the study, 559 were diagnosed with CVD. Elevated UHR values were strongly associated with a greater incidence of CVD and its subtypes, including congestive heart failure, myocardial infarction, angina, and coronary heart disease (all P < 0.001). After accounting for weighted factors, participants in the higher UHR quartiles presented progressively higher rates of CVD: Quartile 1 (4.7%), Quartile 2 (6.3%), Quartile 3 (7.4%), and Quartile 4 (11%). A nonlinear relationship between the UHR and the risk of developing CVD was identified through restricted cubic spline (RCS) analysis. Among the subgroup of 4,117 participants with dyslipidemia, multivariable linear regression analysis demonstrated a significant positive association between the UHR and dyslipidemia (OR 17.38, 95% CI 16.24-18.60). This association remained robust even after adjusting for covariates (OR 11.65, 95% CI 8.995-15.17). RCS analysis further confirmed the nonlinear nature of this relationship. Subgroup analysis revealed no significant interaction between the UHR and overall CVD or CVD-related variables, such as congestive heart failure, myocardial infarction, angina, or coronary heart disease. However, for dyslipidemia, BMI showed a significant interaction, indicating that the positive association between the UHR and dyslipidemia risk is influenced by participants' BMI.

CONCLUSION

A high UHR is associated with an increased risk of various cardiovascular conditions and dyslipidemia. The incorporation of routine UHR monitoring into clinical practice can support the early identification of high-risk individuals, facilitate timely interventions, and reduce the burden of cardiovascular and metabolic diseases.

Predictive value of TG/HDL-C and GFR-adjusted uric acid levels on cardiovascular mortality: the URRAH study

BACKGROUND

Insulin resistance (IR) and serum uric acid (SUA) are closely interconnected: SUA contributes to adversely affects the insulin signaling pathway and contributes to IR, while IR is a known predictor for the development of hyperuricemia. The triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio has been proposed as an easily obtainable marker for IR. This research aimed to investigate the interaction between IR and glomerular filtration rate (GFR)-adjusted uricemia (SUA/GFR ratio) in determining CV risk in a large population cohort study.

METHODS

Data from 18,694 subjects were analyzed from Uric acid Right foR heArt Healt (URRAH) database. The study evaluated the association between TG/HDL-C ratio and SUA/GFR ratio, as well as their impact on the development of outcomes during the follow-up study period. The primary endpoint was CV mortality.

RESULTS

After a mean follow-up of 124 ± 64 months, 2,665 (14.2%) CV deaths occurred. The incidence of fatal and non-fatal CV events increased in parallel with the increase of TG/HDL-C quintiles. TG/HDL-C ratio showed a positive association with increasing of SUA/GFR ratio, even in non-diabetic patients. Multivariate analysis showed that the TG/HDL-C ratio increases the mortality risk even after adjustment for potential confounding factors. Finally, IR and GFR-adjusted hyperuricemia showed an additive effect on CV mortality.

CONCLUSIONS

Both IR and SUA/GFR ratio independently predict CV mortality, regardless of age, gender, BMI, diabetes, hypertension and statin use. The joint effect of the TG/HDL-C ratio and the elevated SUA/GFR ratio was greater than the presence of each single risk factor on CV mortality. This highlights the importance of monitoring these markers to better assess cardiovascular risk.

Association between serum uric acid-to-high-density lipoprotein cholesterol ratio and metabolic dysfunction-associated steatotic liver disease among Chinese children with obesity

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the most prevalent chronic liver diseases worldwide. The serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has been recognized as a novel marker for metabolic diseases, including MASLD. However, all previous studies were performed in adults.

Objectives

To explore the relationship between the UHR and MASLD in Chinese children with obesity.

Methods

A retrospective study was conducted including 1284 obese children hospitalized at Beijing Children's Hospital between January 2016 and December 2022. Logistic regression analysis and restricted cubic splines were performed to assess the association between the UHR and the odds of MASLD. The receiver operator characteristic (ROC) curve analysis was used to estimate the diagnostic value of UHR for MASLD in children with obesity.

Results

The prevalence of MASLD was high, which reached 61.76% in children with obesity. UHR levels were higher in obese children with MASLD than those with non-MASLD for both genders. After dividing all individuals into three groups according to the tertiles of UHR, the prevalence rate of MASLD increased progressively from the tertile 1 to tertile 3 of UHR (34.11% vs. 70.56% vs. 80.61%). Logistic regression analysis showed that obese children with higher UHR levels were significantly associated with MASLD risk, independent of confounding factors such as age, gender, body mass index (BMI), fasting blood glucose (FBG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and creatinine (Cr). The non-linear relationship analysis demonstrated that a UHR between approximately 300 and 900 suggested a saturation effect of MASLD risk. ROC analysis indicated that UHR might serve as a predictive marker for diagnosing MASLD in obese children.

Conclusions

In children with obesity, UHR is significantly associated with MASLD and might serve as a novel and useful predictor for MASLD onset.

Effect of cumulative uric acid to high-density lipoprotein cholesterol ratio on myocardial infarction in prospective cohorts

OBJECTIVE

This study aimed to investigate the effect of the ratio of cumUHR on MI, based on the hypothesis that higher exposure to the ratio of cumUHR is associated with a higher risk of MI.

METHODS

Participants who underwent three examinations between 2006 and 2010 were selected. The cumUHR from baseline to the third check was calculated, multiplying the mean between consecutive checks by the time interval between visits. The association between cumUHR and MI and its progression was evaluated by Cox proportional hazards regression model. The cumulative incidence of endpoint events between cumUHR groups was compared using a log-rank test. Stratification by age, sex, and BMI was further performed.

RESULTS

A total of 53,697 people, with an average age of 53.08 years, 78 % of whom were male, with a median follow-up of 10.51 years and 744 myocardial infarction events, were enrolled. The highest cumUHR quartile, MI, had the highest cumulative incidence (log-rank P < 0.01). Multivariate COX regression analysis showed that in the fully adjusted model, there was a high level of concentration in the highest cumUHR quartile (HR, 1.52; 95 % CI, 1.20-1.92) and participants with longer duration of high UHR exposure (HR, 1.55; 95 % CI, 1.22-1.97).

CONCLUSIONS

The risk of MI increases with cumUHR and is influenced by the time course of cumUHR. In particular, in people aged ≥ 60 years, males, and BMI < 28 kg/m2, the risk of MI is more affected by the level of UHR, and more attention should be paid to controlling the level of UHR.

Association of serum uric acid to high-density lipoprotein cholesterol ratio with all-cause and cardiovascular mortality in patients with diabetes or prediabetes: a prospective cohort study

Background and aims

The serum uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) is a novel biomarker that indicates inflammation and metabolic disorders. Also, it has been shown that UHR correlates with the risk of cardiovascular disease. Despite this, limited research exists on its prognostic significance. This study aimed to explore the association of UHR with all-cause and cardiovascular mortality in patients with diabetes or prediabetes.

Methods

This cohort study included 18,804 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2018 with diabetes or prediabetes aged 20 years or older, followed until December 31, 2019. Patients with diabetes or prediabetes were grouped according to quartiles of UHR, which was calculated as serum UA (mg/dL)/HDL-C (mg/dL). Kaplan-Meier survival analysis, multivariable Cox proportional hazards regression models, restricted cubic spline analysis, and threshold effects were performed to assess the association between baseline UHR and all-cause and cardiovascular mortality. Subgroup analysis and sensitivity analysis were also conducted.

Results

During a median follow-up of 80 months, a total of 2,748 (14.61%) deaths occurred, including 869 (4.63%) cardiovascular deaths. Kaplan-Meier survival analysis revealed that the highest quartile of UHR had the highest mortality rates. Multivariable Cox regression analysis indicated that individuals in the highest quartile of UHR had a significantly higher risk of all-cause mortality (HR: 1.24, 95% CI: 1.07-1.45) and cardiovascular mortality (HR: 1.56, 95% CI: 1.19-2.04) compared to those in the second quartile. A J-shaped association between UHR and both all-cause and cardiovascular mortality was observed, with threshold points of 13.73% and 9.39%, respectively. Specifically, when UHR was above the respective thresholds, the HRs of a 10% increment of UHR for all-cause mortality and cardiovascular mortality were 1.45 (95% CI: 1.31-1.61) and 1.38 (95% CI: 1.20-1.60). However, UHR below the threshold did not significantly correlate with mortality. Furthermore, subgroup analyses showed that the correlation of UHR with all-cause mortality was significantly modified by sex and age, with a persistent positive correlation observed in women and those aged < 60.

Conclusion

Higher UHR was correlated with increased all-cause and cardiovascular mortality in patients with diabetes or prediabetes.

Relationship between uric acid to HDL ratio and extent and severity of coronary artery disease

Introduction

Coronary artery disease (CAD) is common worldwide and is a significant cause of morbidity and mortality. CAD is a chronic and inflammatory disease mainly caused by atherosclerosis. SYNTAX and Gensini scoring systems are used to evaluate CAD extent and severity. Uric acid to high-density lipoprotein (HDL) ratio (UHR) increases in inflammatory conditions.

Aim

To investigate the relationship between UHR and the extent and severity of CAD and its correlation with SYNTAX and Gensini scoring systems.

Material and methods

894 patients who underwent angiography were included in the study. 612 participants with critical coronary stenosis were designated as the patient group, and 282 participants without stenosis were designated as the control group. Characteristic features and laboratory parameters of the groups were compared. The relationship between the SYNTAX and Gensini scores of the patient group and UHR was analyzed.

Results

Baseline characteristics and laboratory parameters were similar in both groups, except for uric acid and UHR levels. Both uric acid levels (7.58 ±2.55 mg/dl vs. 5.71 ±1.46 mg/dl, p < 0.01) and UHR (0.2016 ±0.094 vs. 0.1461 ±0.05, p < 0.01) were significantly higher in the patient group. UHR levels were found to be correlated significantly with both scoring systems. In the ROC curve analysis the UHR cut-off value of 0.1567 was able to predict CAD moderately (AUC = 0.669 (0.634-0.704), sensitivity 61.1%, specificity 38.7%).

Conclusions

UHR is an easy-to-use parameter that can be used before invasive evaluation to predict the presence, severity, and extent of CAD.

The serum uric acid-to-high-density lipoprotein cholesterol ratio is a predictor for all-cause and cardiovascular disease mortality: a cross-sectional study

Objective

The exact relationship between the serum uric acid-to-HDL cholesterol ratio (UHR) and mortality rates remains enigmatic among American adults. This study aims to clarify the association between UHR and both all-cause and cardiovascular disease (CVD) mortality in US adults.

Methods

This study enrolled 48054 patients from the National Health and Nutrition Examination Survey (NHANES). Mortality outcomes were determined by linking to National Death Index (NDI) records up to December 31,2019. Multivariate Cox proportional hazards models were constructed to analyze explore the associations between UHR and mortality. Dose-response relationships were explored using restricted cubic splines, and stratified analyses were conducted based on gender, age, race, education, PIR, smoking status, alcohol intake, physical activity, BMI, diabetes and hypertension.

Results

During the follow-up period, the overall mortality for all-cause and CVD was 10.9% and 2.7%, respectively. The adjusted HRs in the highest quintile were 1.16 (95% CI: 1.05, 1.29) for all-cause mortality and 1.2 (95% CI: 1, 1.45) for CVD mortality. In diabetes, obese, and CVD subgroups, significantly elevated adjusted HRs were observed for both all-cause and CVD mortality. Specifically, diabetes patients had adjusted HRs of 1.32 (95% CI: 1.11, 1.57) and 1.38 (95% CI: 1.01, 1.90), obese individuals had HRs of 1.32 (95% CI: 1.10, 1.58) and 1.55 (95% CI: 1.06, 2.28), and CVD patients had HRs of 1.29 (95% CI: 1.10, 1.50) and 1.38 (95% CI: 1.06, 1.79), respectively. A non-linear relationship between UHR and mortality was identified, with critical thresholds of 12.4 for all-cause mortality and 10.7 for CVD mortality in the general population. Significant interactions were observed between UHR and stratified variables, including gender, BMI, education, smoking, alcohol use, and hypertension for all-cause mortality, while significant interactions were observed based on gender, smoking, and alcohol intake for CVD mortality. Comparable trends were also observed in patient with diabetes, obese and CVD.

Conclusions

In this cohort study, we provide novel insights into the association between serum UHR concentrations and mortality in the general population. UHR is a strong predictor of all-cause and cardiovascular mortality in the general population.

Uric acid-to-high-density lipoprotein cholesterol ratio and osteoporosis: Evidence from the national health and nutrition examination survey

Background: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has emerged as a novel indicator of inflammatory and metabolic status. This study aims to examine the association between UHR and bone mineral density (BMD), as well as the risk of osteoporosis, in individuals aged ≥50 years. Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey, focusing on participants aged ≥50 years. Femoral neck BMD (FN-BMD) was measured using dual-energy X-ray absorptiometry. Linear regression models were employed to examine the association between UHR and FN-BMD. Additionally, generalised additive models were used to assess the nonlinear relationship between UHR and FN-BMD. Logistic regression models were employed to evaluate the association between UHR and the risk of osteoporosis. Results: Finally, the study included 2963 adults with a mean age of 64.16 ± 8.92 years. Linear regression analyses revealed a positive association between UHR and FN-BMD, regardless of covariate adjustments. Logistic regression analyses indicated that elevated UHR was associated with a reduced risk of osteoporosis with or without covariate adjustments. Subgroup analyses revealed that the positive association between UHR and BMD was significant in individuals aged ≥65 years but not in those aged 50 to 64 years. Interaction analyses by age showed significant differences after adjusting for all covariates. Conclusions: Clinicians should be vigilant regarding the potential risk of osteoporosis in individuals with a low UHR. UHR might serve as a risk indicator for osteoporosis.

Predictive value of the serum uric acid to high-density lipoprotein cholesterol ratio for culprit plaques in patients with acute coronary syndrome

BACKGROUND

Hyperuricemia and low level of high-density lipoprotein cholesterol (HDL-C) are both risk factors for coronary artery disease (CAD). The uric acid to HDL-C ratio (UHR) has recently been identified as a new inflammatory and metabolic biomarker. However, the relationship between the UHR and coronary culprit plaques has not been fully investigated in patients with acute coronary syndrome (ACS).

METHODS

A total of 346 patients with ACS were enrolled in this study. Culprit lesion characteristics were assessed by optical coherence tomography (OCT). Logistic regression and linear correlation analyses were performed to assess the association between the UHR and culprit plaques. The predictive value of the UHR was investigated by receiver operating characteristic (ROC) curve analysis.

RESULTS

The percentages of typical culprit plaques, including ruptures, erosions and thrombi, were greater in the high-UHR subgroup than those in the low-UHR subgroup. A positive relationship was also found between the UHR and diameter stenosis (r = 0.160, P = 0.003) and between the UHR and area stenosis (r = 0.145, P = 0.007). The UHR was found to be independently associated with plaque rupture, erosion and thrombus. Furthermore, ROC analysis suggested that the UHR had a better predictive value than low-density lipoprotein cholesterol.

CONCLUSIONS

An elevated UHR level was independently related to the occurrence rate of culprit plaques. The UHR is a simple and easily acquired parameter for detecting culprit plaques in patients with ACS.

Associations of Serum Uric Acid to High-Density Lipoprotein Cholesterol Ratio with Trunk Fat Mass and Visceral Fat Accumulation

Background

It has been reported recently that the ratio of uric acid to high-density lipoprotein cholesterol (UHR) is correlated with several metabolic disorders. The present study aimed to investigate the associations of UHR with body fat content and distribution.

Methods

This study enrolled 300 participants (58 men and 242 women) aged 18 to 65 years. The levels of serum uric acid and high-density lipoprotein cholesterol were measured by standard enzymatic methods. The overall fat content and segmental fat distribution were assessed with an automatic bioelectrical impedance analyzer. In the population with obesity, the visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using magnetic resonance imaging.

Results

Among the study population, 219 individuals (73.0%) were with obesity. The median level of UHR in individuals with obesity was 33.7% (26.2% - 45.9%), which was significantly higher than that in those without obesity [22.6% (17.0% - 34.4%), P < 0.01]. UHR was positively associated with overall fat content and segmental fat distribution parameters (all P < 0.01). In multivariate linear regression analysis, compared with body mass index, waist circumference was more closely associated with UHR (standardized β = 0.427, P < 0.001) after adjusting for confounding factors. Additionally, total fat mass (standardized β = 0.225, P = 0.002) and trunk fat mass (standardized β = 0.296, P = 0.036) were more closely linked to UHR than total fat-free mass and leg fat mass, respectively. In the population with obesity, VFA was independently correlated with UHR (P < 0.01), while SFA was not associated with UHR.

Conclusion

UHR was significantly associated with overall fat content and trunk fat accumulation. In the population with obesity, UHR was positively associated with VFA. Attention should be paid to the role of excessive trunk fat mass in the relationship between UHR and metabolic disorders.