OBJECTIVES: To use electronic health records (EHR) data to evaluate relationships of serum uric acid (SrUA) levels with hypertension and hyperlipidemia in patients with gout. METHODS: This retrospective study used de-identified EHR data from the Humedica database between 2010 and 2013. Patients were adults (≥18 years) with ≥2 ICD-9-CM diagnosis codes for gout ≥30 days apart (first diagnosis = index event), with ≥1 SrUA assessments, and ≥6 months pre- and ≥12 months post-index activity. Hypertension and hyperlipidemia were based on ICD-9 codes; patients with a hypertension or hyperlipidemia diagnosis during the 6-month pre-index period were excluded. Patients were stratified by SrUA quartiles: 0.01-4.0mg/dL (n=2730), 4.1-6.0mg/dL (n=4349), 6.1-8.0mg/dL (n=6136), and ≥8.1mg/dL (n=5744). RESULTS: Patients were male (76.8%), white (81.1%) with mean±SD age of 60.5±14.1 years and mean±SD Charlson Comorbidity Index of 0.63±1.20. There were no significant differences across SrUA quartiles for proportions of patients diagnosed with hyperlipidemia 12-months post-index, which ranged from 37.6% (4.1-6.0mg/dL) to 38.2% (0.01-4.0mg/dL). In contrast, the ≥8.1mg/dL quartile had a significantly higher incidence of hypertension, 60.3% (P<0.001 versus all other quartiles), and the 0.01-4.0mg/dL quartile was significantly greater relative to the 4.1-6.0mg/dL quartile (56.1% vs 53.6%; P<0.05) but similar to the 6.1-8.0mg/dL quartile (54.5%). The diagnosis of hypertension or hyperlipidemia was made concurrently with the index event in 28.5% and 16.8% of patients, respectively. CONCLUSIONS: High SrUA appears associated with increased risk of hypertension; very low SrUA may also be associated with hypertension risk. Approximately 20% of patients were diagnosed with hypertension or hyperlipidemia concurrently with the gout diagnosis, suggesting that gout was the event that initiated recognition of these comorbidities, and that, at least in this population, healthcare encounters may be symptomatically driven, with lower utilization for preventive care. Further evaluation of the relationship between SrUA and onset of hypertension and hyperlipidemia is warranted.