Uric Acid-To-High-Density Lipoprotein Cholesterol Ratio and Peripheral Arterial Disease: A Cross-Sectional Study from...

To examine the association between the serum uric acid-to-high-density lipoprotein cholesterol (HDL-C) ratio (UHR) and peripheral arterial disease (PAD) among U.S. adults.

This cross-sectional study used data from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). PAD was defined as ankle-brachial index (ABI) <0.90 in either leg. Weighted multivariable logistic regression was used to estimate odds ratios (ORs) for PAD according to UHR modeled continuously and by quartiles. Restricted cubic spline (RCS) regression, subgroup analyses, interaction tests, sensitivity analyses, stratified receiver operating characteristic (ROC) analyses, and propensity score matching (PSM) were performed.

A total of 6,149 participants were included, among whom 459 had PAD (7.5%). Each one-unit increase in UHR was associated with higher odds of PAD (OR, 1.04, P = 0.004). The highest UHR quartile (≥14.47) was associated with 52% higher odds of PAD compared with the lowest quartile (<7.78) (P = 0.036). RCS analysis showed an overall association (P for overall = 0.006) without evidence of a statistically significant nonlinear pattern (P for nonlinearity = 0.375). Stratified ROC analysis identified optimal cut-offs of 10.69 for the overall population (area under the curve [AUC] = 0.577), 12.55 for statin users (AUC = 0.602), and 9.82 for nonstatin users (AUC = 0.554). PSM confirmed the overall association (P = 0.027), with significance retained only among statin users (P = 0.002). Subgroup and sensitivity analyses generally supported the robustness of the findings.

Higher UHR is independently associated with PAD. UHR may serve as an adjunctive screening marker, particularly for statin users (cut-off ≥12.55).