Background: Young adults, especially those under 35, are often overlooked; however, previous studies have shown that coronary artery disease (CAD) incidence increases rapidly. Previous studies proved many risk factors for CAD, such as hyperlipidemia, hypertension, diabetes, and smoking. The present study ultimately aimed to figure out the correlation between Hyperuricemia (HUA) and smoking in CAD Patients under the age of 35. Methods: This observational study included 100 young adults (18–35 years of age) suspected of CAD. We used the Gensini Score system to ascertain coronary angiography outcome and CAD; based on the number of affected vessels, localization of the segment, and the stenosis grade. The Gensini score being > 0 indicated the presence of CAD. Results: In young adults under 35, there was a significant correlation between HUA and CAD. The interaction between HUA and smoking had a contrast for CAD that statistically shown the existence of CAD increased in patients who have hyperuricemia and non-smokers compared to smokers. Conclusions: By monitoring various parameters in young adults ≤ 35 years old. This study strengthens the correlation between:1) hyperuricemia and the occurrence of CAD, 2) Smoking and the CAD. Furthermore, there is a clear association between HUA and the occurrence of CAD in non-smokers.