Association between a high total cholesterol-to-high-density lipoprotein cholesterol ratio and hyperuricemia among patients with hypertension: A cross-sectional study from central Uganda

Abstract

Background: Hyperuricemia is a cardiometabolic risk factor among patients with hypertension. A high total cholesterolto- high-density lipoprotein cholesterol ratio reflects atherogenic lipid imbalance and insulin resistance. This study investigated the association between a high total cholesterol-to-high-density lipoprotein cholesterol ratio and hyperuricemia among patients with hypertension at Uganda Heart Institute. Methods: We conducted a cross-sectional study among 277 consecutively recruited patients with hypertension aged ≥18 years from 4 August 2025 to 20 October 2025 at Uganda Heart Institute. Hyperuricemia was defined as a serum uric acid level of ≥7 mg/dL in men and ≥6 mg/dL in women, whereas a high total cholesterol-to high-density lipoprotein cholesterol ratio was defined as ≥5. Results: Among 277 participants, 89 had hyperuricemia, giving a proportion of 32.1% (95% confidence interval: 26.9– 37.9). Hyperuricemia was significantly more common in participants with a total cholesterol-to-high-density lipoprotein cholesterol ratio of ≥5 (53.8%) than in those with a ratio of <5 (25.5%) (p < 0.001). After adjustment for confounders, a high total cholesterol-to-high-density lipoprotein cholesterol ratio remained independently associated with hyperuricemia (adjusted odds ratio = 2.83, 95% confidence interval: 1.31–6.09, p=0.008). The total cholesterol-to-high-density lipoprotein cholesterol ratio demonstrated moderate predictive ability for hyperuricemia, with an optimal cutoff value of 4.33 (sensitivity, 58%; specificity, 71%) and an area under the curve of 0.68 (95% confidence interval: 0.61–0.75). Conclusion: Hyperuricemia is prevalent among patients with hypertension. A high total cholesterol-to-high-density lipoprotein cholesterol ratio is a potential predictor of hyperuricemia in this population