Cross-sectional analysis links elevated uric acid-to-HDL ratio with diabetes risk in stroke survivors, suggesting improvements in risk stratification using body mass index as a mediator.
Diabetes mellitus (DM) significantly elevates cerebrovascular risk in stroke survivors, yet metabolic predictors specific to this population remain underexplored. The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) encapsulates pro-oxidant and anti-atherogenic pathways relevant to DM pathogenesis, but its clinical utility in stroke cohorts is unestablished. This cross-sectional study analyzed 1999 to 2018 National Health and Nutrition Examination Survey data from 964 adults with stroke history (representing 3,481,079 U.S. adults). UHR was standardized into sex-stratified z -scores. DM was defined by American Diabetes Association criteria. Generalized variance inflation factors (GVIF) confirmed absence of multicollinearity (all GVIF (1/(2*Df)) < 5). Weighted multivariable logistic regression assessed UHR-DM associations across 3 models: unadjusted (model 1), sex/age-adjusted (model 2), and fully adjusted for clinical covariates (model 3). Restricted cubic splines evaluated nonlinearity, piecewise regression identified effect thresholds, and time-dependent receiver operating characteristic analysis assessed predictive performance with inverse probability weighting. Mediation analysis quantified body mass index (BMI)’s intermediary role. Elevated UHR z -scores demonstrated dose-dependent DM associations, with quartile 4 (Q4) exhibiting 3.12-fold higher odds (95% confidence interval [CI]: 1.86–5.25, P < .001) in model 3. Restricted cubic splines revealed significant nonlinearity ( P < .05), identifying UHR z -score = −0.419 (raw value = 0.088) as an inflection point: below this threshold, each 1-unit increase conferred 3.39-fold higher DM risk (95% CI: 1.56–7.40, P = .002); above it, risk increased 1.20-fold (95% CI: 1.08–1.45, P = .041). BMI mediated 38% of the total effect (β = 0.04, 95% CI: 0.03–0.06; P < .001). A rea under the curve (AUC) for UHR z -scores predicting DM improved from 0.61 (unadjusted) to 0.68 (model 3-adjusted). Subgroup analyses showed effect modification by sex ( P for interaction < .05). In stroke survivors, UHR elevation independently suggests DM risk through threshold-dependent mechanisms, with BMI mediating over one-third of this relationship. UHR assessment could enhance DM risk stratification in poststroke care.
No takes yet. Share an insight, caveat, or question.
Zhu et al. (2025) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: