Background: To investigate the impact of uric acid (UA) levels on cardiovascular disease and mortality at a population level. Methods: Prospective analysis of baseline serum UA measurement and 15year follow-up data from the Busselton Health Survey (n=4,173), stratified by existence or absence of baseline cardiovascular disease. Outcomes were ascertained from state-wide hospital discharge and mortality registries. Cox regression produced adjusted hazard ratios (HR) for UA level as continuous and categorical (low, medium, high) predictor for cardiovascular events (CVE) and mortality. Gout was defined as a patient's self-reported history of gout. Results: After age and gender adjustment each 0.1mmol/L rise in UA level was associated with increased mortality (HR 1.19, CI 1.04-1.36), cardiovascular mortality (HR 1.27, CI 1.03-1.57) and first CVE (HR 1.28, CI 1.13-1.44) in participants with no history of CVE. Adjustment for behavioural and biomedical risk factors of cardiovascular disease attenuated these associations. Results for participants with a history of CVE and for a subset of 1,632 participants using UA levels (2-6 measurements) averaged over time were similar. The overall prevalence of hyperuricemia was 10.7%. When stratified by history of gout, UA level was significantly associated with increased risk of cardiovascular mortality only in participants with a history of CVE (HR 2.13, CI 1.03-4.43). Conclusions: Despite the considerable prevalence of hyperuricemia in 10.7% of the population, single or time averaged measures of UA were not independently predictive of incident cardiovascular disease or mortality. Hyperuricemia did associate with an increased risk of cardiovascular death only in participants with gout and existing cardiovascular disease.