Uric acid-to-HDL cholesterol ratio and incident stroke: Competing-risk models in the China Health and Retirement Longitudinal Study.

Prior cross-sectional studies have reported an association between the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) and stroke, but prospective cohort evidence is limited. We conducted a prospective cohort study using eligible Wave 1 participants from the China Health and Retirement Longitudinal Study who reported no prior stroke and had fasting blood samples with available UHR values. Incident stroke through Waves 2 to 5 was defined by self-reported physician diagnosis; event time was assigned to the midpoint between the first wave reporting stroke and the preceding wave. Fine-Gray subdistribution hazard models were used with death as a competing event. Dose-response was assessed using restricted cubic splines. UHR was modeled continuously (per 10-unit increase), by quartiles, and using an unsupervised clustering approach (C1 vs C2). Multivariable and sensitivity analyses were performed. Among 10,103 participants followed for a median of 9 years, 864 incident strokes and 1258 deaths occurred. Restricted cubic splines showed no evidence of nonlinearity (P for nonlinearity = .481). Higher UHR was associated with higher incident stroke risk in fully adjusted competing-risk models (subdistribution hazard ratio [sHR] per 10-unit increase, 1.13 [95% confidence interval [CI], 1.02-1.27]). In quartile analyses, the highest UHR quartile (Q4) was associated with higher stroke risk vs Q1 (sHR, 1.28 [95% CI, 1.06-1.55]). In clustering analyses, C2 was associated with higher stroke risk vs C1 (sHR, 1.19 [95% CI, 1.03-1.38]). In this prospective China Health and Retirement Longitudinal Study cohort, higher UHR was associated with a modestly higher risk of incident stroke in competing-risk analyses accounting for death. UHR may support stroke risk stratification in community settings and warrants validation with adjudicated outcomes and stroke subtype data.