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. 2025 Jun 2:16:1577077.
doi: 10.3389/fneur.2025.1577077. eCollection 2025.

Increased uric acid to high-density lipoprotein ratio positively correlated with stroke risk

Tieshi Zhu #  1 , Yong He #  2 , Erxinxian Bei  1   3
Affiliations

Increased uric acid to high-density lipoprotein ratio positively correlated with stroke risk

Tieshi Zhu et al. Front Neurol. .

Abstract

Background: The Uric Acid-to-HDL Ratio (UHR), a novel index derived from serum uric acid and high-density lipoprotein, has been linked to hypertension and poor diabetes control. It has also been shown to predict ischemic heart disease and is strongly associated with collateral circulation and coronary artery flow reserve. However, fewer studies have focused on the relationship between UHR and stroke, highlighting the need for further research in this area.

Methods: The study included 33,192 individuals from the NHANES 1999-2023, of whom 1,363 had a history of stroke. The nonlinear relationship between UHR and stroke risk was assessed using restricted cubic spline (RCS) analysis, and the robustness of the findings was further tested through stratified analysis. Logistic regression was employed to analyze the relationship between UHR and stroke risk, considering both UHR as a continuous variable and its categorization into quartiles (Q1-Q4).

Results: UHR was not nonlinearly associated with stroke (p for overall <0.01; p for nonlinearity = 0.65), and the RCS graph approximated a straight line with a positive slope. UHR was significantly associated with an increased risk of stroke, both when analyzed as a continuous variable (Model 4: OR = 1.02, 95% CI 1.01-1.03, p < 0.01) and when categorized into quartiles (Q4, OR = 1.31, 95% CI 1.11-1.55, p < 0.01).

Conclusion: There was a significant positive correlation between UHR and stroke risk.

Keywords: NHANES; UHR; cross sectional study; public health; stroke.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participant inclusion and exclusion process. NHANES, National Health and Nutrition Examination Survey; HDL, high density lipoprotein; PIR, poverty-to-income ratio.
Figure 2
Figure 2
RCS analysis of UHR and stroke. (A–C) UHR and stroke risk in NHANES 1999–2023 (A), 1999–2010 (B), and 1999–2004 (C). (D–F) log-transformed UHR and stroke risk in NHANES 1999–2023 (D), 1999–2010 (E), and 1999–2004 (F). NHANES, National Health and Nutrition Examination Survey; UHR, uric acid-to-HDL ratio.
Figure 3
Figure 3
Subgroup analysis of UHR and stroke. UHR, uric acid-to-HDL ratio.
Figure 4
Figure 4
Discriminatory ability of UA, HDL, and UHR for stroke risk assessment. UA, uric acid; HDL, high density lipoprotein; UHR, uric acid-to-HDL ratio; AUC, area under curve. p-values were calculated using DeLong’s test for correlated ROC curves.
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