Lai Xiaoli, Chen Tao
Department of Endocrinology and Metabolism, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.
Front Endocrinol (Lausanne). 2024 Dec 5;15:1476336. doi: 10.3389/fendo.2024.1476336. eCollection 2024.
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.
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.
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.
Higher UHR was correlated with increased all-cause and cardiovascular mortality in patients with diabetes or prediabetes.
血清尿酸（UA）与高密度脂蛋白胆固醇（HDL-C）的比值（UHR）是一种表明炎症和代谢紊乱的新型生物标志物。此外，已有研究表明UHR与心血管疾病风险相关。尽管如此，关于其预后意义的研究仍然有限。本研究旨在探讨UHR与糖尿病或糖尿病前期患者全因死亡率和心血管死亡率之间的关联。
这项队列研究纳入了2005 - 2018年美国国家健康与营养检查调查（NHANES）中18,804名年龄在20岁及以上的糖尿病或糖尿病前期参与者，随访至2019年12月31日。糖尿病或糖尿病前期患者根据UHR的四分位数进行分组，UHR的计算方法为血清UA（mg/dL）/HDL-C（mg/dL）。采用Kaplan-Meier生存分析、多变量Cox比例风险回归模型、限制性立方样条分析和阈值效应来评估基线UHR与全因死亡率和心血管死亡率之间的关联。还进行了亚组分析和敏感性分析。
在中位随访80个月期间，共发生2,748例（14.61%）死亡，其中包括869例（4.63%）心血管死亡。Kaplan-Meier生存分析显示，UHR最高的四分位数死亡率最高。多变量Cox回归分析表明，与第二四分位数的个体相比，UHR最高四分位数的个体全因死亡率（HR：1.24，95%CI：1.07 - 1.45）和心血管死亡率（HR：1.56，95%CI：1.19 - 2.04）的风险显著更高。观察到UHR与全因死亡率和心血管死亡率之间呈J形关联，阈值分别为13.73%和9.39%。具体而言，当UHR高于各自阈值时，UHR每增加10%，全因死亡率和心血管死亡率的HR分别为1.45（95%CI：1.31 - 1.61）和1.38（95%CI：1.20 - 1.60）。然而，低于阈值的UHR与死亡率无显著相关性。此外，亚组分析表明，UHR与全因死亡率的相关性在性别和年龄方面有显著改变，在女性和年龄<60岁的人群中观察到持续的正相关。
较高的UHR与糖尿病或糖尿病前期患者全因死亡率和心血管死亡率的增加相关。
