EASIX was positively and nonlinearly associated with serum uric acid levels among US adults, with serum uric acid levels plateauing at an EASIX value of approximately 1.31, suggesting a 'threshold saturation' effect.
EASIX index showed a significant positive correlation with serum uric acid levels after full adjustment for covariates.
Serum uric acid levels increased with rising EASIX quartiles in a dose-response trend.
The relationship between EASIX and serum uric acid was nonlinear, exhibiting a 'threshold saturation' effect at an EASIX value of approximately 1.31.
Higher EASIX quartiles were associated with increased odds of hyperuricemia in exploratory analysis.
Subgroup and sensitivity analyses confirmed the robustness of the positive association between EASIX and serum uric acid across demographic characteristics and disease statuses.
The study used a cross-sectional design based on 12 years of NHANES data spanning 2007–2018.
This research suggests that a laboratory measure called the Endothelial Activation and Stress Index (EASIX) — which combines blood markers to estimate stress on the inner lining of blood vessels — is positively linked to uric acid levels in the blood among U.S. adults. Using health data from over 7,600 Americans collected between 2007 and 2018, the researchers found that as EASIX scores rose, so did uric acid levels, even after accounting for other health factors that could explain the relationship. People in the highest EASIX quartiles also appeared more likely to have hyperuricemia, a condition defined by abnormally high uric acid that is associated with gout and cardiovascular problems. However, the relationship was not a simple straight line. Statistical modeling revealed that uric acid levels rose with EASIX up to a certain point — around an EASIX score of 1.31 — and then appeared to level off, a pattern the authors describe as a 'threshold saturation' effect. This means the strongest association between endothelial stress and uric acid may occur at lower-to-moderate EASIX values, with diminishing returns at higher levels. These findings held up across different demographic groups and disease categories, suggesting the association is broadly applicable. This research suggests that EASIX may serve as a useful marker for understanding how endothelial (blood vessel lining) dysfunction relates to metabolic problems like elevated uric acid. Because the study is cross-sectional — meaning it looked at one point in time — it cannot prove that endothelial stress causes changes in uric acid or vice versa. The authors call for future prospective studies and external validation before EASIX could be considered for clinical use in predicting or monitoring uric acid-related conditions.
Wu H, Tang H, Liu M, Zhu Y, Li Y. (2026). Association between Endothelial Activation and Stress Index (EASIX) and uric acid levels: A cross-sectional analysis based on the NHANES.. Medicine. https://doi.org/10.1097/MD.0000000000050443