OBJECTIVES Hyperuricemia is an independent risk factor for gouty arthropathy, renal disease, atherosclerosis and cardiovascular diseases (CVD). The objective of this study was to explore the relationship between serum uric acid (SUA) levels and hospitalization events and assess health care costs. METHODS A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Subjects, aged ≥ 18, were assigned to one of the 4 groups based upon the first SUA measurement between October 1, 2010 and September 30, 2011: ≤6 mg/dl [good-control], >6 mg/dl and ≤ 7 mg/dl [fair-control], >7 mg/dl and ≤8 mg/dl [poor-control], >8 mg/dl [very-poor-control]. We calculated incidence rates to estimate the risk of hyperuricemia-related and CVD hospitalizations occurred until December, 2012. A Poisson regression model was used to assess the relationship between the number of CVD hospitalizations and SUA level. Total annual costs included all the pharmacological treatments and the direct costs due to hospitalizations and outpatient services. RESULTS Of 52,822 patients included, SUA level was ≤ 6 mg/dl -good-control- for 33,638 (63.7%) patients and >6 mg/dl –suboptimal-control- for 19,184 patients (36,3%), of whom 60,7% with fair-control, 25,8% poor-control and 13,5% very-poor-control. Compared with good-control group, suboptimal-control patients showed an increased risk of hyperuricemia-related hospitalizations (unadjusted rate was 1,02 vs 0,43 per 1000 person-years, p<0.001) and of CVD hospitalizations (unadjusted rate 5,09 vs 3,17 per 100 person-years, p<0.001; adjusted incidence rate ratio 1.22, p<0.001). Over one year, the mean total cost was: €2,077.43 in good-control patients; €2,079.87 in fair-control patients; €2,296.39 in poor-control patients; €3,295.41 in very-poor-control patients. CONCLUSIONS The 36,3% of the patients in this study sample were at sub-optimal SUA control (>6mg/dl). This analysis indicates that higher hyperuricemia-related and CVD hospitalizations as well as total health care costs resulted associated with higher SUA levels.