Russo Elisa, Viazzi Francesca, Pontremoli Roberto, Angeli Fabio, Barbagallo Carlo Maria, Berardino Bruno, Bombelli Michele, Cappelli Federica, Casiglia Edoardo, Cianci Rosario, Ciccarelli Michele, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, D'Elia Lanfranco, Desideri Giovambattista, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Grassi Guido, Iaccarino Guido, Imbalzano Egidio, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Masulli Maria, Mazza Alberto, Mengozzi Alessandro, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Salvetti Massimo, Tikhonoff Valerie, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Virdis Agostino, Volpe Massimo, Borghi Claudio
Dipartimento Di Medicina Interna E Specialita Mediche, Università Degli Studi Di Genova, Genoa, Liguria, Italy.
IRCCS Ospedale Policlinico San Martino, Genoa, Liguria, Italy.
Lipids Health Dis. 2025 Jan 24;24(1):21. doi: 10.1186/s12944-025-02440-w.
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.
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.
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.
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.
胰岛素抵抗（IR）与血清尿酸（SUA）密切相关：SUA会对胰岛素信号通路产生不利影响并导致IR，而IR是高尿酸血症发生的已知预测指标。甘油三酯（TG）与高密度脂蛋白胆固醇（HDL-C）的比值已被提议作为一种易于获取的IR标志物。本研究旨在通过一项大型人群队列研究，探讨IR与肾小球滤过率（GFR）校正的尿酸血症（SUA/GFR比值）在确定心血管风险中的相互作用。
从尿酸对心脏健康有益（URRAH）数据库中分析了18694名受试者的数据。该研究评估了TG/HDL-C比值与SUA/GFR比值之间的关联，以及它们在随访研究期间对结局发生的影响。主要终点是心血管死亡率。
平均随访124±64个月后，发生了2665例（14.2%）心血管死亡。致命和非致命心血管事件的发生率随着TG/HDL-C五分位数的增加而平行上升。即使在非糖尿病患者中，TG/HDL-C比值与SUA/GFR比值的升高也呈正相关。多变量分析表明，即使在调整潜在混杂因素后，TG/HDL-C比值仍会增加死亡风险。最后，IR和GFR校正的高尿酸血症对心血管死亡率显示出相加作用。
无论年龄、性别、体重指数、糖尿病、高血压和他汀类药物的使用情况如何，IR和SUA/GFR比值均能独立预测心血管死亡率。TG/HDL-C比值与升高的SUA/GFR比值的联合作用对心血管死亡率的影响大于每个单一危险因素。这突出了监测这些标志物以更好地评估心血管风险的重要性。
