Uric acid-to-high-density lipoprotein cholesterol ratio and incident vascular calcification in patients with type 2 diabetes mellitus: a retrospective cohort study
9 affiliations
- 1Department of Endocrinology, Central Hospital of Dalian University of Technology
- 2General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University
- 3Laboratory Pathology Department, Ningbo Clinical Pathology Diagnosis Center
- 4Department of Respiratory Medicine, Yanhu District People’s Hospital of Yuncheng
- 5China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences and Peking Union Medical College
- 6Department of Neuroendocrine Pharmacology, School of Pharmacy, China Medical University
- 7Graduate School, Dalian Medical University
- 8Department of Internal Medicine, Traditional Chinese Medicine Hospital of Dalian Pulandian District
- 9Department of Endocrinology, The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University
Abstract
Background: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is a composite marker that has been associated with all-cause and cardiovascular mortality in individuals with diabetes mellitus (DM). However, evidence on the association between UHR and vascular calcification (VC) remains limited and is derived primarily from cross-sectional studies of abdominal aortic calcification (AAC) in the general population. Whether UHR is associated with incident VC in patients with type 2 diabetes mellitus (T2DM) remains unclear, and longitudinal evidence in this population is lacking.
Methods: This single-center retrospective cohort study included 767 hospitalized adults with T2DM who showed no evidence of VC on their initial chest computed tomography (CT). UHR was calculated using serum uric acid (SUA) and high-density lipoprotein cholesterol (HDL-C) concentrations measured during the first hospitalization. Incident coronary and/or aortic calcification was identified on follow-up chest CT examinations. The association between UHR and incident VC was evaluated using Kaplan–Meier curves with log-rank tests, multivariable Cox regression models, restricted cubic spline analysis, exploratory piecewise Cox regression, subgroup analyses, and sensitivity analyses incorporating log-transformed UHR.
Results: During a median follow-up of 25 months (IQR, 11–53), 351 participants (45.8%) developed incident VC. In the fully adjusted model, each 1-standard deviation (SD) increase in UHR was associated with a 24.5% higher hazard of incident VC (hazard ratio, 1.245; 95% confidence interval, 1.117–1.387; P < 0.001). Compared with Q1, the adjusted HRs for Q2, Q3, and Q4 were 1.636, 1.921, and 1.876, respectively (P for trend < 0.001), although the quartile-specific estimates did not follow a strictly monotonic pattern. Restricted cubic spline analysis demonstrated a significant overall association between UHR and incident VC (P for overall < 0.001), whereas the test for nonlinearity was not statistically significant (P for nonlinearity = 0.058). No significant interactions were observed in prespecified subgroup analyses, and the findings remained robust across sensitivity analyses, including analysis using log-transformed UHR.
Conclusions: Higher UHR was associated with a greater hazard of incident coronary and/or aortic calcification in patients with T2DM. These findings extend previous cross-sectional evidence by providing longitudinal data and warrant further evaluation of UHR as a potential marker of VC risk.
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BibTeX
@article{he2026uric,
title = {{Uric acid-to-high-density lipoprotein cholesterol ratio and incident vascular calcification in patients with type 2 diabetes mellitus: a retrospective cohort study}},
author = {Taoyuan He and Xin Wang and Guosheng Li and Xue Liang and Yuntong Liu and Bing Wang and Yudan Liu and Wei Zhao and Zhu Zhu and Xue Yao and Yue Xiao and Xuhan Liu},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1964678},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1964678/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Uric acid-to-high-density lipoprotein cholesterol ratio and incident vascular calcification in patients with type 2 diabetes mellitus: a retrospective cohort study
AU - Taoyuan He
AU - Xin Wang
AU - Guosheng Li
AU - Xue Liang
AU - Yuntong Liu
AU - Bing Wang
AU - Yudan Liu
AU - Wei Zhao
AU - Zhu Zhu
AU - Xue Yao
AU - Yue Xiao
AU - Xuhan Liu
PY - 2026
DA - 2026/10/09
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1964678
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1964678/full
AB - Background: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) is a composite marker that has been associated with all-cause and cardiovascular mortality in individuals with diabetes mellitus (DM). However, evidence on the association between UHR and vascular calcification (VC) remains limited and is derived primarily from cross-sectional studies of abdominal aortic calcification (AAC) in the general population. Whether UHR is associated with incident VC in patients with type 2 diabetes mellitus (T2DM) remains unclear, and longitudinal evidence in this population is lacking. Methods: This single-center retrospective cohort study included 767 hospitalized adults with T2DM who showed no evidence of VC on their initial chest computed tomography (CT). UHR was calculated using serum uric acid (SUA) and high-density lipoprotein cholesterol (HDL-C) concentrations measured during the first hospitalization. Incident coronary and/or aortic calcification was identified on follow-up chest CT examinations. The association between UHR and incident VC was evaluated using Kaplan–Meier curves with log-rank tests, multivariable Cox regression models, restricted cubic spline analysis, exploratory piecewise Cox regression, subgroup analyses, and sensitivity analyses incorporating log-transformed UHR. Results: During a median follow-up of 25 months (IQR, 11–53), 351 participants (45.8%) developed incident VC. In the fully adjusted model, each 1-standard deviation (SD) increase in UHR was associated with a 24.5% higher hazard of incident VC (hazard ratio, 1.245; 95% confidence interval, 1.117–1.387; P < 0.001). Compared with Q1, the adjusted HRs for Q2, Q3, and Q4 were 1.636, 1.921, and 1.876, respectively (P for trend < 0.001), although the quartile-specific estimates did not follow a strictly monotonic pattern. Restricted cubic spline analysis demonstrated a significant overall association between UHR and incident VC (P for overall < 0.001), whereas the test for nonlinearity was not statistically significant (P for nonlinearity = 0.058). No significant interactions were observed in prespecified subgroup analyses, and the findings remained robust across sensitivity analyses, including analysis using log-transformed UHR. Conclusions: Higher UHR was associated with a greater hazard of incident coronary and/or aortic calcification in patients with T2DM. These findings extend previous cross-sectional evidence by providing longitudinal data and warrant further evaluation of UHR as a potential marker of VC risk.
SN - 1664-2392
ER -