Uric acid-to-high-density lipoprotein cholesterol ratio and incident vascular calcification in patients with type 2 diabetes mellitus: a retrospective cohort study

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.