The predictive performance of the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) for cardiovascular diseases in cancer patients: A cross-sectional study from NHANES

Figure 1.. Enrollment pathway for participants. The diagram illustrates the sequential exclusion criteria applied to NHANES 1999–2020 data, beginning with 107,622 individuals. After removing participants under 20 years of age or pregnant (n = 50,351), those without valid cancer status (n = 52,077), and those missing CVD or UHR data (n = 504), a final analytical sample of 4690 cancer patients was included in the study. CVD = cardiovascular disease, UHR = uric acid-to-high-density lipoprotein cholesterol ratio.

Figure 2.. Association between UHR and CVD in cancer patients using RCS regression. The plot illustrates a linear positive relationship between UHR (%) and the OR of cardiovascular disease. The solid red line represents the estimated OR, while the dashed lines indicate the 95% confidence interval. The model was fully adjusted for age, sex, race/ethnicity, education, PIR, marital status, BMI, smoking status, drinking status, diabetes, hypertension, and total cholesterol. P-overall < 0.001; P for non-linearity = .081. BMI = body mass index, CI = confidence interval, CVD = cardiovascular disease, OR = odds ratio, PIR = poverty income ratio, RCS = restricted cubic spline, TC = total cholesterol, UHR = uric acid-to-high-density lipoprotein cholesterol ratio.

Figure 3.. Subgroup analyses of the association between UHR and CVD in cancer patients. The forest plot presents ORs and 95% CIs for cardiovascular disease across multiple subgroups stratified by demographic and clinical characteristics. Interaction P values were calculated to assess effect modification. All subgroup models were fully adjusted for age, sex, race/ethnicity, education, PIR, marital status, BMI, smoking status, drinking status, diabetes, hypertension, and total cholesterol. BMI = body mass index, CI = confidence interval, CVD = cardiovascular disease, OR = odds ratio, PIR = poverty income ratio, TC = total cholesterol, UHR = uric acid-to-high-density lipoprotein cholesterol ratio.

Figure 4.. ROC curve for evaluating the discriminative ability of UHR for CVD among cancer patients. The AUC was 0.61 (95% CI: 0.59–0.63), with an optimal cutoff value of 11.889%. The corresponding sensitivity and specificity were 0.54 and 0.63, respectively, indicating only a modest discriminative capacity. AUC = area under the curve, CI = confidence interval, ROC = receiver operating characteristic.