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Uric acid-to-HDL cholesterol ratio and incident stroke: Competing-risk models in the China Health and Retirement
Yilin Liang1, Runzhui Lin2, Yingying Deng3
1Department of Neurology, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, Guangdong, China.
Insights
Higher uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is linked to increased stroke risk. This prospective study in China found UHR may help identify individuals at higher risk for stroke.
Area of Science:
- Cardiovascular Epidemiology
- Biomarker Research
- Public Health
Background:
- Cross-sectional studies suggest a link between the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and stroke.
- Prospective cohort evidence for this association is limited, necessitating further investigation.
Purpose of the Study:
- To investigate the association between UHR and incident stroke in a prospective cohort.
- To evaluate UHR as a potential biomarker for stroke risk stratification.
Main Methods:
- Prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHRLS).
- Incident stroke was tracked over a median of 9 years using self-reported physician diagnosis.
- Fine-Gray subdistribution hazard models were employed, accounting for death as a competing event.
Main Results:
- Higher UHR was associated with a modestly increased risk of incident stroke (sHR per 10-unit increase: 1.13; 95% CI, 1.02-1.27).
- The highest UHR quartile showed a significantly higher stroke risk compared to the lowest quartile (sHR: 1.28; 95% CI, 1.06-1.55).
- Clustering analysis identified a distinct group (C2) with higher stroke risk compared to another group (C1) (sHR: 1.19; 95% CI, 1.03-1.38).
Conclusions:
- Elevated UHR is associated with a modestly increased risk of incident stroke in a Chinese population.
- UHR may serve as a valuable tool for stroke risk stratification in community settings.
- Further validation with adjudicated outcomes and stroke subtype data is warranted.
Abstract:
Prior cross-sectional studies have reported an association between the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and stroke, but prospective cohort evidence is limited. We conducted a prospective cohort study using eligible Wave 1 participants from the China Health and Retirement Longitudinal Study who reported no prior stroke and had fasting blood samples with available UHR values. Incident stroke through Waves 2 to 5 was defined by self-reported physician diagnosis; event time was assigned to the midpoint between the first wave reporting stroke and the preceding wave. Fine-Gray subdistribution hazard models were used with death as a competing event. Dose-response was assessed using restricted cubic splines. UHR was modeled continuously (per 10-unit increase), by quartiles, and using an unsupervised clustering approach (C1 vs C2). Multivariable and sensitivity analyses were performed. Among 10,103 participants followed for a median of 9 years, 864 incident strokes and 1258 deaths occurred. Restricted cubic splines showed no evidence of nonlinearity (P for nonlinearity = .481). Higher UHR was associated with higher incident stroke risk in fully adjusted competing-risk models (subdistribution hazard ratio [sHR] per 10-unit increase, 1.13 [95% confidence interval [CI], 1.02-1.27]). In quartile analyses, the highest UHR quartile (Q4) was associated with higher stroke risk vs Q1 (sHR, 1.28 [95% CI, 1.06-1.55]). In clustering analyses, C2 was associated with higher stroke risk vs C1 (sHR, 1.19 [95% CI, 1.03-1.38]). In this prospective China Health and Retirement Longitudinal Study cohort, higher UHR was associated with a modestly higher risk of incident stroke in competing-risk analyses accounting for death. UHR may support stroke risk stratification in community settings and warrants validation with adjudicated outcomes and stroke subtype data.
