Analysis of the association between small dense low-density lipoprotein cholesterol and hyperuricemia and development of a nomogram model

A complex association exists between hyperuricemia (HUA) and lipid metabolism disorders. As a key lipid biomarker, small dense low-density lipoprotein cholesterol (sdLDL-C) is increasingly recognized as a marker of cardio-cerebrovascular risk. Nevertheless, the independent correlation between sdLDL-C and HUA has not been clarified. This study aimed to explore their relationship and construct a nomogram. A single-center cross-sectional study was carried out among physical examination participants at Shulan (Hangzhou) Hospital from January 2024 to January 2025. Eligible participants were divided into the HUA group and non-hyperuricemia (Non-HUA) group. Candidate covariates were pre-specified based on clinical knowledge and fitted into hierarchically nested multivariable logistic regression models. Discrimination (area under the receiver operating characteristic curve, AUC), calibration, decision curve analysis and 1000 bootstrap resamples with optimism correction were used for model assessment and internal validation. A total of 650 participants were enrolled, of whom 198 (30.5%) had HUA. Compared with non-HUA participants, those with HUA had a higher proportion of men and higher BMI, triglyceride and sdLDL-C levels and lower high-density lipoprotein cholesterol (HDL-C) levels (all P < 0.05). In the fully adjusted multivariable model, sdLDL-C (OR = 2.827, 95% CI: 1.607–4.972, P < 0.001), hypertension (OR = 1.921, 95% CI: 1.213–3.042, P = 0.005), BMI (OR = 1.077, 95% CI: 1.005–1.155, P = 0.036), age (OR = 0.973, 95% CI: 0.950–0.996, P = 0.020) and serum creatinine (OR = 1.046, 95% CI: 1.027–1.066, P < 0.001) were independently associated with HUA. Restricted cubic spline analysis supported a linear dose–response relationship ( P for overall association = 0.002; P for non-linearity = 0.639). A nomogram achieved an AUC of 0.788 (95% CI: 0.751–0.826), with a sensitivity of 78.8% and a specificity of 68.1%; calibration was adequate (Hosmer–Lemeshow P = 0.328), and the bootstrap-corrected AUC and calibration slope were 0.781 and 0.962. In this study, sdLDL-C was independently associated with hyperuricemia in a linear dose–response pattern. The nomogram incorporating sdLDL-C showed adequate discrimination and calibration, and may serve as a potential auxiliary tool for hyperuricemia risk prediction and preliminary cardiometabolic risk assessment in the general population.