Huang Jingjing, Chen Chunrong
Cardiac Intensive Care Unit, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Limb Trauma and Hand Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China.
Medicine (Baltimore). 2025 Mar 28;104(13):e41962. doi: 10.1097/MD.0000000000041962.
Dyslipidemia and hyperuricemia are recognized as significant risk factors for cardiovascular and metabolic diseases. However, the relationship between the novel lipid metabolism marker, non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), and serum uric acid levels or hyperuricemia remains unclear. This study aimed to analyze these associations using data from a nationally representative population, with an emphasis on sex-specific differences and nonlinear relationships. Data from the National Health and Nutrition Examination Survey conducted from 2005 to 2018 were examined, involving 9439 adults, following the application of exclusion criteria. Weighted linear and logistic regression models categorized by sex were used to investigate the relationships between NHHR, uric acid concentrations, and hyperuricemia. Nonlinear relationships were assessed using restricted cubic splines, and threshold effects were explored using 2-part regression models. Subgroup analyses were conducted to evaluate potential modifiers of the relationship between NHHR and hyperuricemia. NHHR was significantly associated with serum uric acid levels and hyperuricemia in the general population with notable sex-specific differences. In females, NHHR was found to have a very significant positive correlation with hyperuricemia (OR 1.44, 95% confidence interval [CI]: 1.31-1.58, P < .001); however, this correlation was not as strong in males (OR = 1.07, 95% CI: 0.95-1.20, P = .20). Repeated analyses with nonlinear models showed that NHHR had a threshold relationship with hyperuricemia concentration which reached its highest level of 3.91 for the general population, with male and female inflection points at 4.637 and 4.452, respectively. Subgroup analyses demonstrated significant interactions with body mass index (BMI), smoking status, and stroke, further highlighting the heterogeneity of the NHHR-hyperuricemia relationship. NHHR is independently associated with serum uric acid levels and hyperuricemia, with significant sex-specific and nonlinear patterns. These findings suggest that the NHHR may serve as a valuable biomarker for assessing hyperuricemia risk, particularly in females. Further research is warranted to explore the underlying mechanisms and the clinical implications of these associations.
血脂异常和高尿酸血症被认为是心血管疾病和代谢性疾病的重要危险因素。然而，新型脂质代谢标志物非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇之比（NHHR）与血清尿酸水平或高尿酸血症之间的关系仍不清楚。本研究旨在利用来自全国代表性人群的数据分析这些关联，重点关注性别差异和非线性关系。在应用排除标准后，对2005年至2018年进行的全国健康和营养检查调查的数据进行了检查，涉及9439名成年人。使用按性别分类的加权线性和逻辑回归模型来研究NHHR、尿酸浓度和高尿酸血症之间的关系。使用受限立方样条评估非线性关系，并使用两部分回归模型探索阈值效应。进行亚组分析以评估NHHR与高尿酸血症关系的潜在调节因素。在一般人群中，NHHR与血清尿酸水平和高尿酸血症显著相关，存在明显的性别差异。在女性中，发现NHHR与高尿酸血症呈非常显著的正相关（比值比1.44，95%置信区间[CI]：1.31 - 1.58，P <.001）；然而，这种相关性在男性中不那么强（比值比 = 1.07，95% CI：0.95 - 1.20，P = 0.20）。用非线性模型进行的重复分析表明，NHHR与高尿酸血症浓度存在阈值关系，一般人群的最高水平为3.91，男性和女性的拐点分别为4.637和4.452。亚组分析显示与体重指数（BMI）、吸烟状况和中风存在显著相互作用，进一步突出了NHHR - 高尿酸血症关系的异质性。NHHR与血清尿酸水平和高尿酸血症独立相关，具有显著的性别特异性和非线性模式。这些发现表明，NHHR可能是评估高尿酸血症风险的有价值生物标志物，尤其是在女性中。有必要进一步研究以探索这些关联的潜在机制和临床意义。
