Uric Acid-to-HDL Cholesterol Ratio Is Associated with Prediabetes and an Adverse Metabolic Profile: Results from the Genetics of Atherosclerotic Disease (GEA) Study

Aims: The uric acid-to-high-density lipoprotein cholesterol ratio (UHR) has emerged as a potential marker of cardiometabolic dysfunction. However, evidence regarding its association with prediabetes remains limited in Hispanic populations. We evaluated the association between UHR and prediabetes in Mexican-Mestizo adults from the Genetics of Atherosclerotic Disease (GEA) study. Methods: This retrospective cross-sectional analysis included 1395 adults without diabetes or coronary artery disease. Prediabetes was defined as fasting glucose levels between 100 and 125 mg/dL. Participants were stratified into sex-specific UHR tertiles. Logistic regression models adjusted for demographic, lifestyle, and cardiometabolic variables were used to evaluate the association between UHR and prediabetes. Results: Mean age was 53 ± 6 years, 51% were women, and 17% had prediabetes. Individuals in the highest UHR tertile exhibited higher adiposity indices, triglycerides, Apo-B, hsCRP, HOMA-IR, and lower HDL-C and adiponectin levels. Prediabetes prevalence increased progressively across UHR tertiles (11%, 15%, and 24%; p < 0.001). After multivariable adjustment, each 0.1-unit increase in UHR was associated with prediabetes (OR 1.65, 95% CI 1.26–2.17). Compared with the lowest tertile, individuals in the highest UHR tertile had more than two-fold higher odds of prediabetes (OR 2.03, 95% CI 1.36–3.05, p < 0.001). A significant interaction between UHR and sex was observed, with a stronger association in women than in men (OR 3.39, 95% CI 2.1–5.5 vs. 1.19, 95% CI 0.84–1.67). Conclusions: Higher UHR was independently associated with prediabetes and an adverse cardiometabolic profile in Mexican-Mestizo adults. UHR may serve as a simple complementary marker of glucose metabolic disturbances.