Uric Acid to Platelet Ratio (UAPR) and Its Link to Lipid Abnormalities: Findings from a Large Cohort Study in Saudi Arabia

<b>Background:</b> Lipid disturbance is a hallmark of cardiometabolic abnormalities and a primary contributor to cardiovascular disease risk. Immunometabolic markers show promise for better risk classification. This study evaluated the uric acid to Platelet ratio (UAPR) as lipid abnormality marker in a broad cohort of Saudi adults. <b>Methods:</b> Data from 7781 adults in the Elta Medical Laboratory database were analysed. Subjects were stratified by lipid status, and UAPR levels were analyzed. Additionally, lipid abnormality distribution across UAPR tertiles and risk profiles, including ROC analysis, were evaluated. <b>Results:</b> UAPR were markedly increased in patients with abnormal lipid profiles while high UAPR (H-UAPR) subjects showed multiple dyslipidemic patterns including elevated levels of triglycerides (TG), low-density lipoprotein (LDL-C), non-high-density lipoprotein (non-HDL-C), and remnant cholesterol (RC), alongside reduced HDL-C levels. Notably, UAPR correlated with all lipid parameters, most strongly and inversely with HDL-C (r = -0.314) and remained independently associated with TG and HDL-C in multivariable regression. Consistently, H-UAPR was common across all dyslipidemic forms, especially low HDL-C, nearly twice as frequent as in N-UAPR (52.4% vs. 35.0%). The odds were specifically increased for low HDL-C (OR = 2.02, <i>p</i> < 0.0001) and a high TC/HDL-C ratio (OR = 2.94, <i>p</i> < 0.0001) in H-UAPR patients. ROC analysis demonstrated that UAPR had moderate yet significant diagnostic performance, particularly for identifying high TC/HDL-C (AUC = 0.671, <i>p</i> < 0.001) and HDL-C (AUC = 0.618, <i>p</i> < 0.001). <b>Conclusions:</b> UAPR shows considerable promise as an immunometabolic marker linked to various dyslipidemic forms with potential for hyperlipidemia screening and stratification, warranting further validation.