Monocyte-to-HDL-Cholesterol Ratio as an Independent Predictor of Cardiovascular Risk in Patients with Hyperuricemia
Abstract
Background: Hyperuricemia contributes to cardiovascular disease (CVD) through oxidative stress, endothelial dysfunction, and chronic inflammation. The monocyte-to-HDL-cholesterol ratio (MHR) is a novel inflammatory biomarker reflecting the balance between pro-inflammatory monocytes and the anti-inflammatory effects of HDL-C. This study aimed to evaluate the relationship between MHR and cardiovascular risk and to determine its predictive value among patients with hyperuricemia. Methods: A cross-sectional analytical study was conducted between July and September 2025, involving 87 patients with hyperuricemia aged 25-65 years at Bahteramas Regional Hospital, Southeast Sulawesi, Indonesia. Hematological and lipid parameters were measured using standardized laboratory methods. Cardiovascular risk was assessed using the Framingham Risk Score (FRS). Spearman correlation, receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression were used for statistical analysis. Results: MHR showed a significant positive correlation with FRS (r=0.30; p=0.005) and a significant negative correlation with HDL-C levels (r=–0.27; p=0.010). ROC analysis demonstrated that MHR had acceptable discriminatory ability for predicting cardiovascular risk, with an AUC of 0.70 (95% CI: 0.59–0.81; p=0.001). The optimal cut-off value was 18.1, yielding 66% sensitivity and 67% specificity. Multivariate logistic regression revealed that MHR remained an independent predictor of cardiovascular risk after adjustment for conventional risk factors (OR=4.68; 95% CI: 1.31–16.70; p=0.018). Conclusion: MHR appears to be a promising and accessible independent biomarker for cardiovascular risk assessment in patients with hyperuricemia. Incorporating MHR into routine clinical evaluation may support earlier cardiovascular risk stratification and preventive interventions, particularly in resource-limited healthcare settings