Association of hyperuricemia and a three-component lifestyle score with elevated cardiometabolic risk: a health-examination-based cross-sectional study

Background: Hyperuricemia (HUA) is increasingly recognized as being associated with cardiometabolic abnormalities, but its relationszhip with available lifestyle indicators in health-examination populations remains uncertain. This health-examination-based cross-sectional study examined whether hyperuricemia is associated with elevated cardiometabolic risk and whether the available three-component lifestyle score modifies this association. Methods: A health-examination-based cross-sectional study was conducted among 24,795 adult residents who attended the Xindian Town Health Center in Fuzhou, China. Participants underwent physical examinations, laboratory testing, and face-to-face questionnaire interviews. Hyperuricemia was defined as serum uric acid >420 umol/L in men and postmenopausal women or >360 umol/L in premenopausal women. Elevated cardiometabolic risk was defined as the presence of at least three of the following components: elevated blood pressure, abdominal obesity, abnormal glucose metabolism, elevated triglycerides, or reduced HDL-C. The TLS (0-3 points) comprised non-current smoking, non-excessive alcohol use, and adequate physical activity; dietary intake was not available and was therefore not included. Logistic regression and interaction analyses were adjusted for age and sex. Because the outcome was common, odds ratios were interpreted as odds rather than risk ratios. Results: The prevalence of non-current smoking, non-excessive alcohol use, and adequate physical activity was 90.9%, 95.6%, and 63.2%, respectively. The numbers of participants with TLS <=1, 2, and 3 were 1,322, 9,593, and 13,880, respectively. After adjustment for age and sex, a TLS of 2 or 3 was not significantly associated with overall elevated cardiometabolic risk compared with TLS <=1. Hyperuricemia was associated with higher odds of elevated cardiometabolic risk (OR = 1.66, 95%CI: 1.53-1.79). The multiplicative interaction between HUA and TLS was not statistically significant (OR = 0.96, 95%CI: 0.85-1.08, P = 0.462). No statistically significant additive interaction was detected (RERI = 0.15, 95%CI: -0.10 to 0.38; AP = 0.09, 95%CI: -0.06 to 0.22; SI = 1.30, 95%CI: 0.84 to 2.16). Conclusion: Hyperuricemia was associated with elevated cardiometabolic risk in this health-examination-based cross-sectional population. The available three-component lifestyle score did not show a statistically significant association with overall elevated cardiometabolic risk or robust interaction with HUA after age- and sex-adjustment. Because diet, socioeconomic factors, renal function, and specific urate-lowering therapy data were unavailable, these findings should be interpreted as hypothesis-generating associations rather than causal effects.