OBJECTIVES:  To determine the association between elevated sUA levels and AMI’s in a population of incident gout patients. Gout has been associated with an increased risk of acute myocardial infarction (AMI), however, less data are available evaluating the relationship between sUA serum levels and AMI’s. METHODS:  A retrospective cohort study was undertaken using data from an integrated healthcare delivery system. Patients needed to be 18 years or older and have a gout diagnosis between January 2001 and December 2010; the first diagnosis in this time period was defined as the index date. Follow-up continued through December 2013. Incident patients had no gout diagnoses or urate lowering therapy for two years prior to the index date. The outcome of interest was a hospitalized, non-fatal AMI. Data were collected on demographics and a standard set of cardiovascular risk factors. Patients were followed until they had an AMI, death, termination of enrollment or end of the study. Cox regression models were used to determine associations between sUA and AMI’s. RESULTS:  54,421 patients with 311,568.7 person-years of follow-up were included in the study. The average age was 58.3 years and 70% were male. During follow-up 1387 AMI’s occurred. A nonlinear relationship existed between sUA and AMI (best described by a squared sUA function). The unadjusted rate of AMI increased from 3.9 per 1000 person-years at sUA between 5-6 mg/dL to 25.6 per 1000 person-years at sUA between 14-22 mg/dL. With the multivariable Cox model, using sUA of 6 mg/dL as the reference, the hazard ratio (HR) for a sUA of 7.0 mg/dL was 1.042 (95% CI, 1.035-1.050) and for a sUA of 11.0 mg/dL was 1.312 (95% CI, 1.252-1.374). CONCLUSIONS:  In this population, elevated sUA was associated with an increased risk of AMI. The relationship was nonlinear and remained significant after controlling for confounders.