# The correlation between the uric acid to high-density lipoprotein cholesterol ratio and stroke

## TL;DR

This study finds that a blood ratio called UHR is linked to higher stroke risk in both U.S. and Chinese populations.

## Contribution

The study establishes UHR as a novel biomarker for stroke risk across diverse populations.

## Key findings

- Elevated UHR levels are positively correlated with increased stroke risk in both U.S. and Chinese populations.
- Each unit increase in UHR corresponds to a statistically significant rise in stroke risk (adjusted OR 1.03–1.06).
- Dose-response trends and subgroup analyses confirm the robustness of the UHR-stroke association.

## Abstract

The uric acid to high-density lipoprotein cholesterol ratio (UHR) is emerging as a novel biomarker reflecting the balance between pro-oxidative and antioxidative pathways. While implicated in various cardiometabolic diseases, its specific correlation with stroke risk, particularly across diverse populations, remains insufficiently characterized. This study aimed to investigate the UHR-stroke link in two independent populations.

This cross-sectional analysis utilized data from 27,439 NHANES participants (2007–2018). We employed survey-weighted multivariable logistic regression to model the UHR-stroke correlation, complemented by restricted cubic splines (RCS) for dose-response relationships and subgroup analyses to assess effect modification. Furthermore, an external validation dataset comprising 1780 patients from The Central Hospital of Shaoyang was recruited to independently validate the primary findings.

A significant positive correlation was consistently observed between elevated UHR levels and increased stroke risk in both populations. Each unit increase in UHR corresponded to an adjusted OR of 1.03 (95% CI: 1.01–1.05) in NHANES and 1.06 (95% CI: 1.02–1.10) in the Chinese dataset. Similarly, an increasing trend in risk was evident across higher UHR quartiles. Dose-response trends were evident in both datasets (P for trend < 0.05), with restricted cubic spline supporting a linear correlation. Subgroup analyses were robust across multiple sensitivity and multivariable-adjusted models.

UHR is consistently and positively associated with stroke risk in both U.S. and Chinese populations. These findings, derived from multi-ethnic and external validation dataset, strengthen the evidence for UHR as a practical biomarker for stroke risk assessment, potentially reflecting underlying oxidative-antioxidant imbalance.