Objective To examine the associations of cumulative serum uric acid to high-density lipoprotein cholesterol ratio (cumUHR) and the trajectories of uric acid to high-density lipoprotein cholesterol ratio (UHR) with the risk of new-onset cardiometabolic multimorbidity (CMM) in middle-aged and older Chinese adults. Methods This study utilized data from the China Health and Retirement Longitudinal Study. A total of 2597 participants who were not diagnosed with CMM at baseline were included. First, K-means clustering analysis was applied to identify UHR trajectories over the 2012–2015 period. In addition, multivariable logistic regression models were used to assess the associations of cumUHR and UHR trajectories with CMM risk. Restricted cubic spline (RCS) model was performed to explore the dose-response relationship between cumUHR and CMM risk. Moreover, subgroup analyses and interaction tests were conducted to examine potential effect modifications by age and sex, etc. Finally, the predictive performance of cumUHR and UHR trajectories for CMM was assessed using receiver operating characteristic (ROC) curve analysis. Results The cumulative incidence of CMM was 3.31%, with 86 cases developing during the follow-up period until 2020. K-means clustering identified three groups of cumUHR trajectories. Multivariable logistic regression found a significant positive association between cumUHR and CMM risk [odds ratio (OR)=43.41, 95% confidence interval (CI) (4.32, 412.06), P=0.001]. Compared to the low-stable trajectory group, individuals in the sustained-high trajectory group had a significantly higher risk of developing CMM [OR=2.48, 95%CI (1.22, 4.99), P=0.011]. RCS analysis demonstrated a linear dose-response relationship between cumUHR and CMM risk (Poverall=0.004, Pnon-linear=0.727). The ROC analysis demonstrated area under the curve values of 0.755 and 0.759 for cumUHR and UHR trajectories, respectively. Conclusions Both cumUHR exposure and a sustained-high UHR trajectory are significantly associated with an increased risk of CMM in middle-aged and older Chinese adults. Long-term dynamic monitoring of UHR is of significant importance for the early prevention of CMM.
