Association of serum uric acid to high-density lipoprotein cholesterol ratio with all-cause and cardiovascular mortality in patients with diabetes or prediabetes: a prospective cohort study

Background and aims 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. Methods 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. Results 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. Conclusion Higher UHR was correlated with increased all-cause and cardiovascular mortality in patients with diabetes or prediabetes.