Time to redefine serum uric acid levels in women: A call for sex-specific cardiometabolic risk thresholds.

AIMS: Serum uric acid (SUA) is routinely measured in clinical practice, but its interpretation remains largely anchored to conventional, gout-oriented or sex-neutral thresholds. This Viewpoint discusses why this approach may underestimate cardiometabolic and vascular risk in women. DATA SYNTHESIS: SUA in women is influenced by hormonal status, renal urate handling, age, adiposity, insulin resistance, inflammation, and menopause. Population-based evidence shows a marked sex- and age-specific trajectory of SUA, with a sharper increase in women after midlife, while outcome studies suggest that women may experience cardiovascular risk at lower SUA concentrations than men. Emerging data also link SUA to arterial stiffness and microvascular dysfunction even within ranges traditionally considered physiological. CONCLUSIONS: SUA should be interpreted as a dynamic, sex-sensitive cardiometabolic biomarker rather than as a fixed biochemical value. Redefining SUA levels in women does not imply urate-lowering therapy for all asymptomatic women, but rather the distinction between gout thresholds and cardiometabolic risk thresholds. Prospective studies are needed to validate sex-, age-, and hormone-specific SUA thresholds for cardiovascular prevention.