OBJECTIVES Despite increasing incidence and substantial prevalence of gout among women, particularly among elderly, no prospective data on the risk factors for gout are available among women. We prospectively evaluated purported risk factors for the risk of incident gout among women and compared them with men. METHODS Using data from the Framingham Heart Study, we prospectively examined over a 52-year period (1948-2001) the relation between prior serum uric acid levels and the risk of incident gout in 2,470 women and 1,951 men. We used Cox proportional hazards models to estimate the relative risk for incident gout by uric acid level after adjusting for age, body mass index, blood glucose level, blood cholesterol level, hypertension, use of diuretics, alcohol consumption, educational level and menopausal status. RESULTS Over a 28-year median follow-up, we documented 304 incident cases of gout, 104 among women. The incidence rates of gout increased with increasing serum uric acid levels, similar to men. For uric acid levels of <5.0, 5.0-5.9, 6.0-6.9, 7.0-7.9 and ≥8.0 mg/dL the incidence rates of gout per 1000 person-years were 0.81, 1.42, 1.83, 6.75, and 13.09, respectively (p for trend <0.0001). The multivariate relative risk (95% CI) for incident gout for every 1.0 mg/dL increase in serum uric acid level was 1.57 (1.38-1.78) among women and 1.52 (1.36-1.71) among men. Other significant predictors of gout in women were age, obesity, hypertension, blood glucose level and diuretic use. CONCLUSIONS These prospective data indicate that higher levels of serum uric acid increase the risk of gout among women in a graded manner, similar to men, and support the notion that serum uric acid is a reliable surrogate marker and precursor of incident gout among women as well. Age, obesity, hypertension, blood glucose level and diuretic use were associated with the risk of incident gout among women.