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. 2025 Jan 24;24(1):21.
doi: 10.1186/s12944-025-02440-w.

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

Elisa Russo  1   2 , Francesca Viazzi  3   4 , Roberto Pontremoli  1   2 , Fabio Angeli  5   6 , Carlo Maria Barbagallo  7 , Bruno Berardino  8 , Michele Bombelli  9 , Federica Cappelli  10 , Edoardo Casiglia  11 , Rosario Cianci  12 , Michele Ciccarelli  13 , Arrigo F G Cicero  14 , Massimo Cirillo  15 , Pietro Cirillo  16 , Lanfranco D'Elia  17 , Giovambattista Desideri  18 , Claudio Ferri  8 , Ferruccio Galletti  17 , Loreto Gesualdo  16 , Cristina Giannattasio  19   20 , Guido Grassi  20 , Guido Iaccarino  17 , Egidio Imbalzano  21 , Luciano Lippa  22 , Francesca Mallamaci  23   24 , Alessandro Maloberti  19   20 , Stefano Masi  10 , Maria Masulli  17 , Alberto Mazza  25 , Alessandro Mengozzi  10 , Maria Lorenza Muiesan  26 , Pietro Nazzaro  27 , Paolo Palatini  11 , Gianfranco Parati  28   29 , Fosca Quarti-Trevano  20 , Marcello Rattazzi  30 , Gianpaolo Reboldi  31 , Giulia Rivasi  32 , Massimo Salvetti  26 , Valerie Tikhonoff  11 , Giuliano Tocci  33   34 , Andrea Ungar  32 , Paolo Verdecchia  35 , Agostino Virdis  10 , Massimo Volpe  33   36 , Claudio Borghi  14   37 ; Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension (SIIA)
Affiliations

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

Elisa Russo et al. Lipids Health Dis. .

Abstract

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.

Keywords: Cardiovascular mortality; Insulin-resistance; Kidney function; TG/HDL-C ratio; Triglycerides; Uric acid.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The URRAH project was performed according to the Declaration of Helsinki for Human Research (41stWorld Medical Assembly, 1990). The processing of the patients’ personal data collected in this study complies with the European Directive on the Privacy of Data. Approval was sought from the Ethical Committee of the coordinating center at the Division of Internal Medicine of the University of Bologna (No. 77/2018/Oss/AOUBo). Informed consent was obtained from all subjects at recruitment. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves for cardiovascular mortality according to TG/HDL-C quintiles adjusted for SUA/GFR ratio, diabetes and body mass index (BMI). Abbreviations: BMI, body mass index; GFR, glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; SUA, serum uric acid
Fig. 2
Fig. 2
Kaplan–Meier survival curves for cardiovascular mortality according to SUA/GFR ratio (above or below the median) and TG/HDL-C quintiles (1°−2°−3° vs 4°−5° quintiles) adjusted for the presence of diabetes and body mass index (BMI). Abbreviations: BMI, body mass index; GFR, glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; SUA, serum uric acid
See this image and copyright information in PMC

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