Department of Endocrinology, Shandong Provincial Hospital, Shandong University; Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Jinan, Shandong, China.
Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China.
Front Endocrinol (Lausanne). 2024 Sep 13;15:1417485. doi: 10.3389/fendo.2024.1417485. eCollection 2024.
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.
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.
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.
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.
尿酸与高密度脂蛋白胆固醇比值（UHR）与美国成年人死亡率之间的确切关系仍不清楚。本研究旨在阐明 UHR 与美国成年人全因和心血管疾病（CVD）死亡率之间的关系。
本研究纳入了来自国家健康和营养检查调查（NHANES）的 48054 名患者。通过与国家死亡指数（NDI）记录链接，确定死亡率，截止日期为 2019 年 12 月 31 日。使用多变量 Cox 比例风险模型分析 UHR 与死亡率之间的关联。使用限制性三次样条探索剂量-反应关系，并根据性别、年龄、种族、教育、贫困收入比（PIR）、吸烟状况、饮酒量、身体活动、BMI、糖尿病和高血压进行分层分析。
在随访期间，全因和 CVD 的总死亡率分别为 10.9%和 2.7%。最高五分位组的调整后的 HR 分别为全因死亡率 1.16（95%CI：1.05，1.29）和 CVD 死亡率 1.2（95%CI：1.01，1.45）。在糖尿病、肥胖和 CVD 亚组中，全因和 CVD 死亡率均观察到明显升高的调整后 HR。具体来说，糖尿病患者的全因和 CVD 死亡率调整后的 HR 分别为 1.32（95%CI：1.11，1.57）和 1.38（95%CI：1.01，1.90），肥胖者的全因和 CVD 死亡率调整后的 HR 分别为 1.32（95%CI：1.10，1.58）和 1.55（95%CI：1.06，2.28），CVD 患者的全因和 CVD 死亡率调整后的 HR 分别为 1.29（95%CI：1.10，1.50）和 1.38（95%CI：1.06，1.79）。确定了 UHR 与死亡率之间的非线性关系，在普通人群中，全因死亡率的临界阈值为 12.4，CVD 死亡率的临界阈值为 10.7。在全因死亡率方面，UHR 与性别、BMI、教育、吸烟、饮酒和高血压等分层变量之间观察到显著的交互作用，而在 CVD 死亡率方面，仅观察到性别、吸烟和饮酒摄入的交互作用。在糖尿病、肥胖和 CVD 的患者中也观察到了类似的趋势。
在这项队列研究中，我们提供了尿酸血清 UHR 浓度与普通人群死亡率之间关系的新见解。UHR 是普通人群全因和心血管死亡率的强有力预测因子。
