Cumulative and Persistently Elevated Serum Uric Acid-to-HDL Cholesterol Ratio and Incident Stroke Risk Among Middle-Aged Chinese Adults: A Landmark Analysis from CHARLS
- 1Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, No. 321 Zhongshan Road, Nanjing 210008, China
Abstract
Objective: To examine the associations of baseline, cumulative average, and persistently elevated serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) with incident stroke among middle-aged Chinese adults. Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS). A dynamic-entry baseline cohort included 7113 stroke-free participants aged 45–60 years at cohort entry with available UHR and follow-up data. A repeated-UHR landmark cohort included 3438 participants with UHR measurements in both 2011 and 2015 who remained free of stroke through the 2015 assessment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident stroke. Baseline UHR was analyzed as a continuous variable and in quartiles. In the landmark cohort, cumulative average UHR and transition patterns across repeated measurements were assessed. Results: In the baseline UHR cohort, 477 incident strokes occurred during follow-up. After full adjustment, baseline UHR was associated with a higher risk of incident stroke (HR 1.082, 95% CI 1.013–1.155), and participants in the highest quartile had a higher risk than those in the lowest quartile (HR 1.458, 95% CI 1.115–1.905). In the repeated-UHR landmark cohort, 250 incident strokes occurred after the 2015 assessment. Cumulative average UHR was associated with incident stroke (HR 1.176, 95% CI 1.060–1.306). Compared with participants with persistently low UHR, those with persistently elevated UHR had a higher risk of incident stroke (HR 1.461, 95% CI 1.063–2.009). Conclusions: Among Chinese adults aged 45–60 years, higher baseline UHR, higher cumulative average UHR, and persistently elevated UHR were associated with a higher risk of incident stroke.
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BibTeX
@article{zhong2026cumulative,
title = {{Cumulative and Persistently Elevated Serum Uric Acid-to-HDL Cholesterol Ratio and Incident Stroke Risk Among Middle-Aged Chinese Adults: A Landmark Analysis from CHARLS}},
author = {Chongxia Zhong and Mingyue Wu and Kefan Mao and Yihai Liu and Biao Xu and Lina Kang},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218264},
url = {https://www.mdpi.com/2077-0383/15/21/8264},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cumulative and Persistently Elevated Serum Uric Acid-to-HDL Cholesterol Ratio and Incident Stroke Risk Among Middle-Aged Chinese Adults: A Landmark Analysis from CHARLS
AU - Chongxia Zhong
AU - Mingyue Wu
AU - Kefan Mao
AU - Yihai Liu
AU - Biao Xu
AU - Lina Kang
PY - 2026
DA - 2026/10/23
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218264
UR - https://www.mdpi.com/2077-0383/15/21/8264
AB - Objective: To examine the associations of baseline, cumulative average, and persistently elevated serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR) with incident stroke among middle-aged Chinese adults. Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS). A dynamic-entry baseline cohort included 7113 stroke-free participants aged 45–60 years at cohort entry with available UHR and follow-up data. A repeated-UHR landmark cohort included 3438 participants with UHR measurements in both 2011 and 2015 who remained free of stroke through the 2015 assessment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident stroke. Baseline UHR was analyzed as a continuous variable and in quartiles. In the landmark cohort, cumulative average UHR and transition patterns across repeated measurements were assessed. Results: In the baseline UHR cohort, 477 incident strokes occurred during follow-up. After full adjustment, baseline UHR was associated with a higher risk of incident stroke (HR 1.082, 95% CI 1.013–1.155), and participants in the highest quartile had a higher risk than those in the lowest quartile (HR 1.458, 95% CI 1.115–1.905). In the repeated-UHR landmark cohort, 250 incident strokes occurred after the 2015 assessment. Cumulative average UHR was associated with incident stroke (HR 1.176, 95% CI 1.060–1.306). Compared with participants with persistently low UHR, those with persistently elevated UHR had a higher risk of incident stroke (HR 1.461, 95% CI 1.063–2.009). Conclusions: Among Chinese adults aged 45–60 years, higher baseline UHR, higher cumulative average UHR, and persistently elevated UHR were associated with a higher risk of incident stroke.
SN - 2077-0383
ER -