Prehyperuricemia Deserves More Attention in this Era of Metabolic Explosion: A Review

The global population is experiencing a metabolic explosion, with the prevalence of hyperuricemia (HU) as a metabolic disorder and a causal factor for noncommunicable diseases (NCD) increasing rapidly worldwide over the last 2 decades. This rise is attributed to diets high in purine, alcohol, red meat, high-fructose foods, and lifestyle changes. The connection between HU and various NCDs is now stronger than ever. As HU progresses, systemic inflammation arises, leading to endothelial dysfunction and end-organ damage-molecular changes that were previously unrecognized. HU is increasingly seen as a metabolic disorder, particularly a vascular disorder rather than just a crystallization disease. Asymptomatic HU is no longer considered benign, and it should not be equated with gout. It is crucial to diagnose HU early, at a high normal level, and manage it to prevent the development and complications of related extra-articular diseases. For broader recognition and significance, this high normal level of serum uric acid (UA) should be termed prehyperuricemia (PHU). Like prediabetes and prehypertension, PHU should be identified early, regardless of age and sex, with preventive actions implemented to maintain UA at a safer level.