The correlates of serum uric acid and the association of uric acid with carotid intimal-medial thickness (an early measure of atherosclerosis) were investigated in participants of the baseline examination of the Atherosclerosis Risk in Communities (ARIC) Study. The study sample included 6522 women (74% white) and 4966 men (79% white) who were aged 45 to 64 years at baseline (1986-1989). Those with prevalent coronary heart disease or previous stroke and those taking uricosuric medication were excluded. The mean (SD) uric acid concentration was 5.9 (1.5) mg/dL. It was highest among black men 45-54 years old (6.9 [1.5] mg/dL), and lowest in white women aged 45-54 years old (5.0 [1.2] mg/dL). The uric acid level was positively correlated in both sexes with a variety of health-related factors, most notably body mass index, creatinine, triglycerides, diuretic use, alcohol intake, hypertension, diabetes, and insulin levels. In a linear regression model adjusting for age and ARIC center, the level of uric acid was directly and significantly associated with B-mode ultrasound carotid intimal-medial thickness in women and white men (but not in black men). However, when known risk factors for atherosclerotic disease and relevant behavioral and biological correlates of uric acid were controlled for in multivariate analysis, the association of uric acid with this early measure of atherosclerosis became negligible in white women and much weaker and not statistically significant in black women and white men. Thus, uric acid itself may not be a risk factor for atherosclerosis. Future analysis of cardiovascular events in the ARIC Study will further elucidate the role of uric acid in atherosclerotic disease.