Objective:

To investigate the association between the uric acid to high-density lipoprotein cholesterol ratio (UHR) and prevalent stroke using NHANES data.

Approach:

• Data Source: Utilized nationally representative data from NHANES 1999–2018, involving 48,918 adults aged ≥20 years.
• Statistical Analysis: Employed survey-weighted multivariable logistic regression and restricted cubic spline models, adjusting for demographic, metabolic, and socioeconomic factors.
• Cohort Validation: Evaluated UHR in an independent Chinese hospital-based cohort with imaging-confirmed hemorrhagic stroke.

Key Findings:

• Higher UHR levels were independently associated with increased odds of prevalent stroke (OR 1.02, 95% CI 1.01–1.03).
• Individuals in the top UHR quartile had approximately 37% higher stroke prevalence compared to those in the lowest quartile (OR 1.37, 95% CI 1.17–1.61).
• The area under the curve (AUC) for cross-sectional discrimination was 0.825, indicating good differentiation of prevalent stroke.
• Diabetes status significantly modified the association, with a stronger relationship observed among non-diabetic individuals.

Interpretation:

The findings support UHR as a clinically accessible marker reflecting metabolic–inflammatory imbalance relevant to cerebrovascular pathology.

Limitations:

• The study's cross-sectional design limits causal inference.
• Potential residual confounding despite adjustments for various factors.
• Generalizability may be limited to specific populations.

Conclusion:

The study highlights the association of UHR with stroke prevalence, suggesting the need for further longitudinal and mechanistic studies.