U-shaped association of uric acid to HDL cholesterol ratio (UHR) with ALL-cause and cardiovascular mortality in diabetic patients: NHANES 1999–2018

To investigate the relationship between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and ALL-cause and cardiovascular mortality among diabetic patients. This study utilized health data from diabetic patients included in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The Kaplan-Meier curves was employed to preliminarily explore the association between UHR, its components, and all-cause and cardiovascular mortality in diabetic patients, as well as to analyze UHR levels and mortality across different genders. Subsequently, the Cox proportional hazards model was used to further investigate the relationship between UHR, its components, and mortality in diabetic patients. Restricted cubic spline (RCS) curves were applied to examine the nonlinear relationship between UHR, its components, and mortality, with a particular focus on the association between UHR and mortality across different genders. This longitudinal cohort study included a total of 6,370 participants, comprising 3,268 males and 3,102 females. Kaplan-Meier analysis revealed a positive correlation between UHR, UA, and mortality in diabetic patients, while the association between HDL and mortality was negligible. The Cox proportional hazards model demonstrated a positive association between UHR and mortality in the diabetic population, while the statistical effects of UA and HDL on mortality were less pronounced compared to UHR. When analyzed by gender, no significant linear relationship was observed between UHR and mortality in either males or females. Subsequently, RCS analysis indicated a U-shaped nonlinear relationship between UHR and mortality in the overall diabetic population and among female patients, with a similar trend observed in males. Furthermore, stratified RCS analysis confirmed the persistence of the U-shaped relationship between UHR and prognosis across most subgroups. This study found a U-shaped relationship between UHR and both ALL-cause and cardiovascular mortality in diabetic population. This suggests that clinicians should control UHR around 9–10 to improve the long-term prognosis of diabetic patients.