Wang Y, Ma GH, Qu MY, Xu QS, Huang HX. Serum uric acid-to-high-density lipoprotein cholesterol ratio and cardiovascular risk in Asian patients with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2025; 31(48): 112972 [DOI: 10.3748/wjg.v31.i48.112972]
Corresponding Author of This Article
Qi-Shui Xu, Department of Anesthesiology, Wuxi No. 2 Chinese Medicine Hospital, No. 390 Xincheng Road, Taihu Sub-district, Binhu District, Wuxi 214121, Jiangsu Province, China. 810204666@qq.com
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Endocrinology & Metabolism
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Retrospective Study
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Dec 28, 2025 (publication date) through Dec 27, 2025
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World Journal of Gastroenterology
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Wang Y, Ma GH, Qu MY, Xu QS, Huang HX. Serum uric acid-to-high-density lipoprotein cholesterol ratio and cardiovascular risk in Asian patients with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2025; 31(48): 112972 [DOI: 10.3748/wjg.v31.i48.112972]
World J Gastroenterol. Dec 28, 2025; 31(48): 112972 Published online Dec 28, 2025. doi: 10.3748/wjg.v31.i48.112972
Serum uric acid-to-high-density lipoprotein cholesterol ratio and cardiovascular risk in Asian patients with metabolic dysfunction-associated steatotic liver disease
Yang Wang, Guang-Hui Ma, Ming-Yue Qu, Qi-Shui Xu, Hai-Xia Huang
Yang Wang, Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi 214100, Jiangsu Province, China
Guang-Hui Ma, Ming-Yue Qu, Hai-Xia Huang, Department of Radiology, Shanghai Health and Medical Center, Wuxi 214065, Jiangsu Province, China
Qi-Shui Xu, Department of Anesthesiology, Wuxi No. 2 Chinese Medicine Hospital, Wuxi 214121, Jiangsu Province, China
Co-first authors: Yang Wang and Guang-Hui Ma.
Co-corresponding authors: Qi-Shui Xu and Hai-Xia Huang.
Author contributions: Wang Y and Ma GH made equal contributions as co-first authors; Wang Y, Xu QS, Ma GH, and Qu MY designed the study; Wang Y, Xu QS, and Ma GH contributed to data analysis; Ma GH and Qu MY contributed to data collection; Ma GH wrote the draft; Xu QS and Huang HX made equal contributions as co-corresponding authors. All authors approved the final version to publish.
Supported by Shanghai Health and Medical Center Star Talent Program, No. 2023QMX01 and No. 2023QMX11.
Institutional review board statement: The study protocol was approved by the Ethics Committee of Shanghai Health and Medical Center, No. LLSC202535.
Informed consent statement: Written informed consent was waived because of the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Shui Xu, Department of Anesthesiology, Wuxi No. 2 Chinese Medicine Hospital, No. 390 Xincheng Road, Taihu Sub-district, Binhu District, Wuxi 214121, Jiangsu Province, China. 810204666@qq.com
Received: August 12, 2025 Revised: September 16, 2025 Accepted: November 12, 2025 Published online: December 28, 2025 Processing time: 137 Days and 20 Hours
Abstract
BACKGROUND
The association between the serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and cardiovascular disease (CVD) risk in Asian populations with metabolic dysfunction-associated steatotic liver disease (MASLD) remains insufficiently elucidated.
AIM
To investigate the relevance and dose-responsive relationship between UHR and 10-year CVD risk among Asian MASLD patients.
METHODS
In this retrospective analysis, 3901 MASLD patients were enrolled based on established screening criteria. As measured by the Framingham risk score, participants were stratified according to their 10-year CVD risk. The association between UHR and CVD risk was evaluated using binary logistic regression, while dose-response patterns were explored through restricted cubic spline (RCS) modeling. The discriminatory capability of UHR, in comparison with conventional biomarkers, was further examined by receiver operating characteristic curve analysis.
RESULTS
Multivariable-adjusted analyses revealed that elevated UHR levels were significantly associated with an increased likelihood of intermediate-to-high CVD risk. RCS modeling demonstrated a linear dose-response relationship between UHR and the Framingham risk score (P for nonlinearity = 0.114). Sex-stratified RCS analyses further indicated that this linear association persisted among males (P for nonlinearity = 0.167) but was not statistically significant in females (P for nonlinearity = 0.476). Further stratified analyses revealed that the association was particularly pronounced among younger individuals (< 50 years), males, and those with central obesity, whereas it was attenuated in older adults (≥ 50 years) and females. Receiver operating characteristic analysis demonstrated that UHR outperformed individual biomarkers in predicting 10-year CVD risk, showing an area under the curve of 0.655 (95% confidence interval: 0.635-0.674).
CONCLUSION
UHR functioned as an independent predictor of 10-year CVD risk in Asian patients with MASLD, demonstrating a linear dose-response association and superior discriminative performance relative to conventional biomarkers, especially among younger individuals, males, and those with central obesity.
Core Tip: This study demonstrated that an elevated uric acid-to-high-density lipoprotein cholesterol ratio (UHR) was independently associated with a higher predicted 10-year CVD risk, as estimated by the Framingham risk score, in a large cohort of Asian patients with metabolic dysfunction-associated steatotic liver disease. A distinct linear dose-response association between increasing UHR levels and CVD risk was observed. Notably, UHR exhibited superior predictive performance compared with conventional biomarkers (area under the curve = 0.655), with an optimal cutoff value of 292. Readily obtainable from routine biochemical testing, UHR thus represents a simple and cost-effective indicator for early CVD risk stratification in patients with metabolic dysfunction-associated steatotic liver disease.
