Mehdi Bazrafshan, Kamran Shamsa, Mehrad Namazee, Maliheh Kamali, Hamed Bazrafshan Drissi, Zahra Hooshanginezhad
UHR is a biologically plausible and reproducible marker associated with multiple cardiovascular outcomes. However, current evidence does not yet establish its independence, superiority, or causal role in CVD. Large prospective cohorts with standardized adjustment, head-to-head biomarker comparisons, and mechanistic studies are required before UHR can be incorporated into routine cardiovascular risk stratification.
AIM: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has emerged as a composite inflammatory-metabolic biomarker with potential relevance to cardiovascular disease (CVD). However, its clinical utility and incremental value remain uncertain. This review aimed to synthesize current evidence regarding the association between UHR and cardiovascular risk, severity, and prognosis.
DATA SYNTHESIS: A structured literature review was conducted across major databases, identifying 51 eligible studies. Evidence was synthesized qualitatively across major cardiovascular domains, including coronary artery disease (CAD), heart failure (HF), hypertension (HTN), stroke, vascular disease, and mortality. Elevated UHR was consistently associated with increased overall CVD risk across diverse populations and was correlated with adverse cardiometabolic profiles. In CAD, higher UHR was linked to greater disease complexity, plaque vulnerability, functionally significant stenosis, and adverse cardiovascular outcome. In HF, elevated UHR was related to higher short-term mortality and readmission. Associations with HTN and stroke were generally positive but showed some heterogeneity across studies. UHR also demonstrated relationships with arterial stiffness, aortic pathology, and both all-cause and cardiovascular mortality, with several studies suggesting a U- or J-shaped relationship. However; most evidence was derived from observational and retrospective analyses with possible residual confounders.
CONCLUSIONS: UHR is a biologically plausible and reproducible marker associated with multiple cardiovascular outcomes. However, current evidence does not yet establish its independence, superiority, or causal role in CVD. Large prospective cohorts with standardized adjustment, head-to-head biomarker comparisons, and mechanistic studies are required before UHR can be incorporated into routine cardiovascular risk stratification.