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

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.