Zhou PM, Yang CT, Bao JF, Huang JS. Letter to the Editor: Precise phenotyping clarifies uric acid-to-high-density lipoprotein cholesterol ratio for cardiovascular risk in metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(29): 119060 [DOI: 10.3748/wjg.119060]
Corresponding Author of This Article
Jin-Song Huang, Chief Doctor, Department of Hepatology, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, No. 2 Hengbu Road, Hangzhou 310023, Zhejiang Province, China. huangjinsongyz@126.com
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Gastroenterology & Hepatology
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letter
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Zhou PM, Yang CT, Bao JF, Huang JS. Letter to the Editor: Precise phenotyping clarifies uric acid-to-high-density lipoprotein cholesterol ratio for cardiovascular risk in metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(29): 119060 [DOI: 10.3748/wjg.119060]
World J Gastroenterol. Aug 7, 2026; 32(29): 119060 Published online Aug 7, 2026. doi: 10.3748/wjg.119060
Letter to the Editor: Precise phenotyping clarifies uric acid-to-high-density lipoprotein cholesterol ratio for cardiovascular risk in metabolic dysfunction-associated steatotic liver disease
Peng-Mei Zhou, Chao-Ting Yang, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Jian-Feng Bao, Jin-Song Huang, Department of Hepatology, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310023, Zhejiang Province, China
Author contributions: Zhou PM and Yang CT drafted and revised the manuscript; Bao JF edited this letter; Huang JS formulated the original idea; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Jin-Song Huang, Chief Doctor, Department of Hepatology, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, No. 2 Hengbu Road, Hangzhou 310023, Zhejiang Province, China. huangjinsongyz@126.com
Received: January 26, 2026 Revised: February 18, 2026 Accepted: April 7, 2026 Published online: August 7, 2026 Processing time: 174 Days and 17.5 Hours
Abstract
This letter concerns the study by Wang et al titled “Serum uric acid-to-high-density lipoprotein cholesterol ratio and cardiovascular risk in Asian patients with metabolic dysfunction-associated steatotic liver disease”, published in World Journal of Gastroenterology. The study demonstrated a linear dose-response association between the uric acid-to-high-density lipoprotein cholesterol ratio and 10-year cardiovascular disease risk in Asian populations with metabolic dysfunction-associated steatotic liver disease. However, reliance on ultrasonography to assess hepatic steatosis under the metabolic dysfunction-associated steatotic liver disease criteria can introduce phenotypic heterogeneity, as this modality cannot reliably distinguish simple steatosis from metabolic dysfunction-associated steatohepatitis or assess the fibrosis stage. We suggest that future studies incorporate more precise phenotyping strategies, such as quantifying steatosis and staging fibrosis, to clarify whether the association between uric acid-to-high-density lipoprotein cholesterol ratio and cardiovascular disease risk is independent of, or modified by, underlying liver disease severity.
Core Tip: The diagnosis of ultrasonography-based metabolic dysfunction-associated steatotic liver disease overlooks hepatic phenotypic heterogeneity and the shared inflammatory metabolic mechanisms of the cardiohepatic axis, potentially confounding the association between uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and cardiovascular disease risk. We argue that precise phenotyping, namely quantification of steatosis using the controlled attenuation parameter or magnetic resonance imaging proton-density fat fraction and staging fibrosis using vibration-controlled transient elastography, is essential to determine whether UHR is an independent predictor of cardiovascular disease risk, thereby clarifying whether UHR is a general biomarker or an indicator of high-risk patients requiring integrated cardiometabolic–hepatic management.
