Cuihua Huang,1 Yan Luo,2 Jianqing Huang,1 Xiuping Qiu,1 Mei Tu1 

1Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China; 2State Grid Longyan Electric Power Supply Company, Longyan, Fujian, 364031, People’s Republic of China

Correspondence: Xiuping Qiu, Email qxp15806017513@163.com Mei Tu, Email tm13859596628@163.com

Background: Carotid atherosclerosis (CAS) is a key diabetic complication needing predictive biomarkers. The serum uric acid-to-high-density lipoprotein cholesterol ratio (UHR), linked to metabolic dysfunction, may serve this role. Therefore, this cross-sectional study examines UHR-CAS association in type 2 diabetes.
Methods: This study included 615 type 2 diabetes patients, collecting demographic, biochemical, and carotid ultrasound data. Spearman correlation analyzed UHR’s relationship with cardiovascular risk factors. Multivariate logistic regression combined with stratified regression modeling assessed UHR’s independent link with CAS, while receiver operating characteristic (ROC) analysis evaluated its predictive value.
Results: CAS patients showed elevated UHR and cardiovascular risk markers (age, body mass index [BMI], homeostatic model assessment of insulin resistance [HOMA-IR], systolic blood pressure, low-density lipoprotein cholesterol [LDL-c], triglycerides, smoking) compared to controls (P < 0.05). UHR tertiles demonstrated dose–response associations with carotid intima-media thickness (cIMT) ≥ 1.0 mm, plaque formation, and CAS (P < 0.05). UHR exhibited positively with BMI, HOMA-IR, systolic blood pressure, triglycerides, uric acid (UA), and cIMT (P < 0.05), but inversely with total cholesterol, high-density lipoprotein cholesterol (HDL-c), and LDL-c (P < 0.05). UHR independently predicted carotid plaques (OR: 1.086, 95% CI: 1.033– 1.142, P = 0.001) and CAS (OR: 1.097, 95% CI: 1.035– 1.162, P = 0.002). Stronger associations occurred in BMI ≥ 25 kg/m² (OR: 1.210, 95% CI: 1.089– 1.345, P < 0.001) and hypertension subgroups (OR: 1.136, 95% CI: 1.033– 1.248, P = 0.008). ROC analysis demonstrated UHR’s superior CAS prediction (AUC = 0.656, 95% CI: 0.611– 0.701, P < 0.01) over triglyceride-to-HDL-c ratio, triglyceride-glucose index, HDL-c, and UA (P < 0.05).
Conclusion: UHR is an independent CAS risk factor in type 2 diabetes, outperforming traditional biomarkers for cardiovascular risk assessment.

Keywords: carotid atherosclerosis, type 2 diabetes mellitus, uric acid-to-high-density lipoprotein cholesterol ratio