Background and objective: Hyperuricemia (HUA) is a metabolic disorder syndrome caused by purine metabolism disorder. This study aims to explore the predictive value of non-high-density lipoprotein cholesterol (non-HDL-c) to high-density lipoprotein cholesterol (HDL-c) ratio (NHHR) for the risk of HUA onset in Chinese population. Method: We extracted data from the China Health and Retirement Longitudinal Study (CHARLS) database from 2011 to 2015. Multivariable logistic regression, restricted cubic splines (RCS) analysis, decision curve analysis (DCA), and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the association between NHHR and risk of developing HUA. Subgroup analyses and sensitivity analyses were also performed. Result: From 2011 to 2015, a total of 6,886 participants met the inclusion criteria of CHARLS. The average age of the participants in this study was 58.5 ± 8.66 years, among whom 3,158 (45.86%) were male. During the median follow-up period of 4.0 years, a total of 616 individuals (8.9%) were diagnosed with HUA. In our study, a higher NHHR was associated with an increased prevalence of HUA (5.8% vs. 7.0% vs. 8.4% vs. 14.6%, P < 0.001). DCA and ROC analyses demonstrate that the NHHR exhibits superior predictive and diagnostic accuracy for hyperuricemia compared with conventional lipid markers. RCS analysis revealed a significant nonlinear association between an increased NHHR and a higher risk of developing HUA. Subgroup analysis indicated that different age groups, drinking status, and different residence area were the significant stratifying factors. The consistency of these findings across multiple sensitivity analyses highlights the robustness of the results. Conclusion: This study reveals a higher NHHR is associated with an increased risk of HUA in the middle-aged and older adults in China. Early detection and appropriate regulation of NHHR can help to prevent and treat HUA in time.

CHARLS, Hyperuricemia, NHHR, Prospective Cohort Study