Association Between Uric Acid / High Density Lipoprotein Ratio and Monocyte / High Density Lipoprotein Ratio with Diabetic Complications

Hemoglobin A1c (HbA1c) continues to serve as the primary retrospective marker to assess glycemic management, but the inability to monitor daily blood glucose fluctuations remains a persistent concern

Uric acid is the final enzymatic product of purine nucleoside and free base degradation. Elevated levels of serum uric acid (SUA) are widely recognized as a risk factor for macrovascular and microvascular complications. Hyperuricemia is particularly common in patients with hyperlipidemia.

It has been established that SUA levels are proportional to triglyceride (TG), total cholesterol (TC), and low-density lipoprotein (LDL) levels. SUA promotes the oxidation of LDL, which is considered to be a key event in atherosclerotic plaque formation. The findings of several epidemiological studies have thus provided evidence to indicate a clear independent association between elevated SUA levels and an increased incidence of atherosclerotic disease or mortality Decreased serum levels of High-density lipoprotein cholesterol (HDL-c) are proposed to be related to worse metabolic status and reduced HDL-c is even a marker of metabolic syndrome.

A combination of these two metabolic parameters uric acid to HDL-c ratio (UHR) which is a more useful predictor of metabolic deterioration High-density lipoprotein- cholesterol acts by reducing proinflammatory responses triggered by monocytes, effectively restricting monocyte proliferation, activation and migration, and plays a role in the anti-oxidant mechanism. In contrast, reduced levels of HDL-c in the blood stream imply a worsening metabolic profile and are a component of the metabolic syndrome Uric acid can cause atherosclerosis and insulin resistance by reducing nitric oxide production, promoting vascular smooth muscle proliferation, and resulting in endothelial dysfunction. Additionally, low levels of HDL-c play a role in the development of metabolic syndrome and insulin resistance.

More recently, the uric acid-to-HDL-c ratio (UHR) has been identified as a marker that increases in inflammatory conditions . Monocytes and macrophages play crucial roles in damage to pancreatic islet cells, islet inflammation and impaired insulin signaling in T2DM. The monocyte/ HDL-c ratio (MHR) has been proposed as an indicator of ongoing low-grade metabolic inflammation and has been suggested studies to be used as a marker for cardiovascular disease and chronic kidney disease .