High levels of uric acid can have serious health implications beyond gout. While only 5% to 19% of people with high uric acid develop gout, it can lead to other issues like arterial plaque, kidney damage, and even erectile dysfunction. 

1. Why do some people have high uric acid without experiencing gout? Uric acid levels can rise when the production exceeds the body's ability to eliminate it.

Clinical guidelines diagnose high uric acid when levels exceed 420 μmol/L. While gout is more likely to occur with extremely high levels, high uric acid still damages various body systems and should be addressed. 

2. Three nighttime signs of high uric acid: body swelling, joint pain, and urinary abnormalities.

High uric acid can cause fluid retention, joint pain due to crystal formation, and urinary issues. 

3. Preventing gout and reducing uric acid levels: 
a) Follow a low-purine, low-fructose diet; b) Stay hydrated; c) Get enough sleep; d) Control weight; e) Take prescribed medication; f) Avoid triggers like cold temperatures and excessive stress.

Doctors recommend medication when uric acid levels exceed 480 μmol/L or 540 μmol/L, depending on the presence of chronic conditions.