Association of The Uric Acid-To-High-Density Lipoprotein Cholesterol Ratio with Coronary Artery Disease in Patients Younger Than 45 Years Presenting with Stable Chest Pain

Q: What are the key findings of this study?

The median uric acid-to-HDL ratio was significantly higher in patients with coronary artery disease compared to those without (0.34 vs 0.08, p<0.001) among adults under 45 with stable chest pain.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Stable chest pain (n=200). Intervention: Uric acid-to-HDL ratio vs. Patients without coronary artery disease. Primary outcome: Median uric acid-to-HDL ratio (p=<0.001).

Q: What does this research mean for the field?

A higher uric acid-to-high-density lipoprotein cholesterol ratio is significantly associated with coronary artery disease in patients younger than 45 years presenting with stable chest pain. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the frequency of coronary artery disease in patients younger than 45 years presenting with stable chest pain and compare their uric acid-to-HDL cholesterol ratio against patients without the disease.

Athar Sajjad; Azhar Ali Chaudhary; Usman Iqbal; Iftikhar Ahmed; Junaid Arshad; Sanaullah Khan

doi:10.51253/pafmj.v76isuppl-9.14094

September 30, 2026Pakistan Armed Forces Medical JournalOpen Access

Association of The Uric Acid-To-High-Density Lipoprotein Cholesterol Ratio with Coronary Artery Disease in Patients Younger Than 45 Years Presenting with Stable Chest Pain

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Key result

Higher uric acid-to-HDL ratio is linked to CAD in young adults with stable chest pain.

P<0.001
n=200

Why the study?

The frequency of coronary artery disease and its association with the uric acid to HDL ratio in patients younger than 45 years presenting with stable chest pain was not well established.

Is the uric acid to HDL ratio associated with the presence of coronary artery disease in patients younger than 45 years presenting with stable chest pain?

Key Points

To assess the frequency of coronary artery disease in patients younger than 45 years presenting with stable chest pain and compare their uric acid-to-HDL cholesterol ratio against patients without the disease.
Enrolled 200 consecutive patients younger than 45 years presenting with stable chest pain at Armed Forces Institute of Cardiology & National Institute of Heart Diseases in Rawalpindi, Pakistan between July and November 2025.
Performed diagnostic coronary angiography under local anesthesia to categorize patients into those with or without coronary artery disease.
Collected venous blood samples to evaluate serum uric acid levels, high-density lipoprotein cholesterol levels, and calculate the uric acid-to-HDL ratio.
Coronary artery disease was identified in 125 of 200 patients (62.5%), with arterial involvement in the left main stem (44 [35.2%]), left circumflex artery (35 [28%]), left anterior descending artery (34 [27.2%]), and right coronary artery (12 [9.6%]).
The median uric acid-to-HDL ratio was significantly higher in patients with CAD at 0.34 (IQR: 0.16) compared to 0.08 (IQR: 0.03) in patients without CAD (p<0.001).
Patients with CAD exhibited significantly elevated median uric acid levels (10.80 [IQR: 4.5] vs. 4.60 [IQR: 1.1] mg/dl, p<0.0001) and markedly reduced median HDL levels (31.00 [IQR: 9] vs. 60.00 [IQR: 15] mg/dl, p<0.0001).

Study Design

Type

Cross-Sectional (n=200)

Multicenter

No

Structured PICO

Is the uric acid to HDL ratio associated with the presence of coronary artery disease in patients younger than 45 years presenting with stable chest pain?

P

Population

200 patients aged 45 years or younger presenting with stable chest pain who underwent coronary angiography at a single center in Pakistan.

E

Exposure

Uric acid to HDL ratio

C

Comparator

Patients without coronary artery disease

O

Outcome

Presence of coronary artery disease (>50% atherosclerotic plaque in vessel lumen on coronary angiography)surrogate

Main Result

Absolute Event Rate: 0.34% vs 0.08%

p-value: p=<0.001

The uric acid-to-HDL ratio is significantly elevated in young patients (≤45 years) with stable chest pain who have angiographically confirmed coronary artery disease, suggesting its potential as an accessible biomarker for early risk stratification.

Limitations

Single-center design and relatively small sample size may limit generalizability
Observational design precludes establishing causality
Potential confounding by other cardiovascular risk factors cannot be excluded
Single-center design
Relatively small sample size

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Implication

Uric acid-to-HDL ratio should not yet inform CAD decisions in young adults with stable chest pain; leaves open its value as a risk marker pending prospective validation.

Abstract

Objective: To investigate the frequency of coronary artery disease in patients younger than 45 years presenting with stable chest pain and then to compare the uric acid to HDL ratio in patients with and without coronary artery disease. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi, Pakistan, from Jul to Nov 2025. Methodology: After meeting the selection criteria, a total of 200 patients were enrolled. Patients underwent coronary angiography. Based on the findings, they were categorized into two groups: with coronary artery disease or without coronary artery disease. The angiographic procedure was performed by a single team of cardiologists with assistance from the researcher, under local anesthesia. Blood samples were collected using a 3 cc disposable syringe to assess the uric acid-to-HDL ratio. Results: In this study, 143(71.5%) were male, 163(81.5%) were hypertensive, and 75(37.5%) were diabetic. Regarding the outcome variable, CAD was detected in 125(62.5%) patients. The median uric acid to HDL ratio was 0.34 (IQR: 0.16) in patients with CAD, compared to 0.08 (IQR: 0.03) in those without CAD (p<0.001). Conclusion: It can be concluded that the frequency of coronary artery disease was 62.5% among patients younger than 45 years presenting with stable chest pain, and the uric acid to HDL ratio showed a significant association with coronary artery disease.

Discussion

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Cite This Study

Sajjad et al. (2026) conducted a cross-sectional in Stable chest pain (n=200). Uric acid-to-HDL ratio vs. Patients without coronary artery disease was evaluated on Median uric acid-to-HDL ratio (p=<0.001). The median uric acid-to-HDL ratio was significantly higher in patients with coronary artery disease compared to those without (0.34 vs 0.08, p<0.001) among adults under 45 with stable chest pain.

synapsesocial.com/papers/6ac19d70aeea5716e8c6c669 https://doi.org/10.51253/pafmj.v76isuppl-9.14094

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Association of The Uric Acid-To-High-Density Lipoprotein Cholesterol Ratio with Coronary Artery Disease in Patients Younger Than 45 Years Presenting with Stable Chest Pain

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of The Uric Acid-To-High-Density Lipoprotein Cholesterol Ratio with Coronary Artery Disease in Patients Younger Than 45 Years Presenting with Stable Chest Pain

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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