OBJECTIVES Gout is a common inflammatory arthritis associated with hyperuricemia. Despite the substantial prevalence of gout among ageing women, little is known about associated cardiovascular risks in this population. Previous studies that have shown an association between gout and acute myocardial infarction (AMI) have been limited to men. Our objective was to evaluate the association between gout and non-fatal AMI among elderly women, aged ≥65 years, and compare findings in men. METHODS We conducted a case control study nested within a population-based gout cohort in the British Columbia Linked Health Database. Over a 12-year follow-up, we identified incident cases of nonfatal AMI from hospitalization data and matched with 5 controls according to age, gender, and length of medical record. Definitions of exposure and outcome were physician-entered ICD-9 codes. Conditional logistic regression models were used to estimate the association between gout and AMI after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS We identified 4821 AMI cases of which 1410 were women. The adjusted odds ratio (OR [95% CI]) of AMI among women with gout was 1.62 (1.21-2.16), higher than the adjusted OR for men (1.12 [0.99-1.26]; p-value for interaction <0.01). When we combined both women and men in our analyses, we found an overall adjusted OR of 1.15 (1.06-1.25). CONCLUSIONS Using population-based data, we found a 62% increased risk for AMI among elderly women with gout, and a 15% increased risk for elderly gout patients overall. The association between hyperuricemia, a known precursor to gout, and cardiovascular disease provides a potential explanation for our findings. Gender differences in serum uric acid levels and metabolism may further explain the difference in risks between women and men. Findings provide support for the aggressive management of cardiovascular risk factors in gout patients.