Lipid-Derived Cardiometabolic Indices in Normouricemic and Hyperuricemic Adults: A Retrospective Cross-Sectional Association Study

Introduction: Hyperuricemia is increasingly recognized as a metabolic disorder linked to dyslipidemia, insulin resistance, and vascular complications. In Saudi Arabia, the prevalence of hyperuricemia is rising with obesity and diabetes, yet its relationship with lipid-derived cardiometabolic indices remained understudied. This study aimed to examine the associations between uricemia status and lipid-derived cardiometabolic indices in a large adult cohort. Methods: This retrospective cross-sectional study analyzed data from 7652 adults, including 5385 normouricemic (NU) and 2267 hyperuricemic (HU). Key cardiometabolic indices, including the triglyceride-glucose index (TyG), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), atherogenic index of plasma (AIP), and Castelli risk indices I and II (CRI-I, CRI-II), were calculated. Associations were evaluated treating HU as the exposure and the lipid-derived cardiometabolic indices as the outcomes. Multivariable regression analyses, receiver operating characteristic (ROC) curves, and prevalence-based association estimates were used to assess these relationships. Results: HU individuals exhibited significantly higher TG along with lowered HDL-C. Median TyG (4.61), AIP (0.38), non-HDL-C (147 mg/dL), RC (18 mg/dL), CRI-I (4.30), and CRI-II (2.85) were higher in the HU group compared to NU group, with non-HDL-C and CRI-I falling within the abnormal range, AIP in the high-risk range, and TyG and CRI-II at borderline levels. Across the separately adjusted models, hyperuricemia showed consistent positive associations with RC, AIP, CRI-I, and CRI-II, whereas associations with TyG and non-HDL-C diminished after adjustment for renal or liver markers. ROC analysis demonstrated modest discriminatory ability of uric acid for elevated indices, with AIP (AUC = 0.641) and CRI-I (AUC = 0.640) exhibiting the highest performance. The prevalence of elevated indices was substantially higher in HU, particularly for CRI-II (44.0% vs. 25.9%) and CRI-I (28.2% vs. 13.7%). Conclusions: These findings highlight associations between HU and lipid-derived cardiometabolic indices, but further longitudinal research is required to determine whether HU has a clinical predictive value in cardiovascular risk assessment.