Objective To investigate the influence of hyperuricemia on inflammatory factors, metabolic indexes and vascular injury in patients with pre impaired fasting blood glucose complicated with obesity. Methods A total of 180 elderly patients with hyperuricemia (HUA) from Yan 'an Hospital Affiliated to Kunming Medical University from January 2019 to June 2023 were selected and divided into normal fasting blood glucose group, early impaired fasting blood glucose group (pre-IFG) and impaired fasting blood glucose group (IFG) according to the fasting blood glucose test results. Each group had 60 cases in each group, and each group was further divided into normal weight subgroup, overweight subgroup and obesity subgroup based on body mass index (BMI). Inflammatory factors, insulin resistance (HOMA-IR), metabolic indicators, vascular endothelial function and IMT were measured. Pearson correlation analysis was used to examine the correlation between uric acid and inflammatory factors, HOMA-IR, vascular endothelial function, and IMT, and a multiple Logistic regression analysis model was constructed to examine its risk factors. Results There were statistically significant differences in inflammatory factors, HOMA-IR, metabolic indicators, vascular endothelial function and IMT among normal FPG group, pre-IFG group and IFG group (P<0.05). Inflammatory factors [C-reactive protein (CRP), interleukin-1β (IL-1 β), interleukin-6 (IL-6)], HOMA-IR, metabolic indicators [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C)], vascular endothelial function [nitric oxide (NO), endothelin-1 (ET-1), brachial artery diameter (D0)] and IMT revealed statistical differences among normal weight subgroup, overweight subgroup and obesity subgroup in normal FPG group, pre-IFG group and IFG group (P<0.05). Pearson correlation analysis results showed that BMI was correlated with IMT (P<0.05). Multiple Logistic regression analysis showed that NO was a protective factor for IMT (P<0.05), while CRP, ET-1, IL-1 β, IL-6 and HOMA-IR are risk factors for IMT (P<0.05). Conclusions HUA can aggravate the inflammatory response of patients with abnormal glucose metabolism and obesity, lead to the deterioration conditions of metabolic indicators, and increase the risk of vascular injury. In clinical practice, it is necessary to pay attention to the management of HUA to reduce the risk of cardiovascular disease in patients.