Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 64 1 2026 02 18 11568 11568 Rana Kolahi Ahari Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. AND International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. Toktam Sahranavard Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. AND International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. Mohsen Moohebati 3 Heart and Vascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Hossein Hatamzadeh Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Maryam Mohammadi-Bajgiran International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. Sahar Ahmadi International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. AND Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Alireza Heidari-Bakavoli Vascular and Endovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Sara Saffar Soflaei International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. AND Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Majid Ghayour-Mobarhan International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. AND Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 03 05 2025 04 02 This study aimed to explore the association between serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and minor and major ischemic electrocardiogram (ECG) changes. The data from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) cohort study comprised 9035 participants aged 35 to 65 years. A 12-lead resting ECG was recorded at baseline for participants. ECG abnormalities were defined according to the Minnesota coding system and classified into three groups: none, minor, and major ischemic changes. Minor and Major ischemic changes were observed in 6.2% and 14.1% of participants, respectively. Participants in the major ischemic group had higher UHR levels compared to those without ischemic changes on their ECG (odds ratio (OR)=0.023, 95% confidence interval (95% CI)=1.011-1.035, P<0.001). UHR remained correlated with major ischemic ECG changes after adjustment for either age (OR=0.019, 95% CI=1.007-1.031, P=0.001) or various cardiovascular risk factors (OR=0.018, 95% CI=1.006-1.030, P=0.004). UHR was not significantly associated with minor ischemic changes. This research showed, for the first time, that UHR was significantly associated with major ischemic ECG changes. Indeed, the UHR provides additional information for risk stratification of subjects with myocardial ischemia.   https://acta.tums.ac.ir/index.php/acta/article/view/11568 https://acta.tums.ac.ir/index.php/acta/article/download/11568/6006