Uric Acid Extremes and Lipid Dysregulation: Evidence from a Large Population-Based Study

Background: Uric acid (UA) exhibits a dual role, with anti-oxidant or pro-oxidant effects determined by its concentration. However, its association with lipid metabolism across different uric acid states remains unclear. This study explored lipid abnormalities across the full uric acid spectrum in a large adult population. Methods: A total of 13,223 adults included in this analysis were classified as hypouricemic, normouricemic, or hyperuricemic based on serum uric acid levels. Lipid profiles, prevalence, associations, risk estimates, and diagnostic accuracy were evaluated using descriptive and multivariate statistical analyses. Results: The prevalence of hyperuricemia was 17.26%, while hypouricemia accounted for 2% of the population. Compared with normouricemia, hyperuricemic subjects exhibited substantially greater levels of LDL, TC, and TG and lower HDL concentrations (all p < 0.0001). Conversely, hypouricemia exhibited elevated HDL and lower LDL, TC, and TG levels, a pattern consistent across sex and age groups. Lipid abnormalities were most frequent among hyperuricemic participants, notably low HDL (45.9%), high LDL (52.8%), high TC (48.2%), and high TG (36.8%). In contrast, hypouricemia was associated with the lowest prevalence and reduced odds of each abnormality. Serum UA correlated significantly with all lipid measures. In multiple regression analysis, UA remained an independent positive predictor of LDL-C (β = 3.45), TC (β = 3.09), and TG (β = 11.33), and a negative predictor of HDL (β = -2.66) after adjusting for age, sex, glycemia status, and renal function. Conclusions: Both UA extremes reflect distinct metabolic states: hyperuricemia showed an adverse lipid profile, whereas hypouricemia was associated with a comparatively more favorable lipid profile, highlighting the association between UA levels and lipid metabolism.