Introduction: There is limited evidence examining the relationship between elevated serum uric acid (sUA) concentration and heart failure (HF) in United States (US) adults. The aim of the present study was to examine the association(s) between elevated sUA and HF using a nationally representative sample of US adults. Methods: The final sample with complete data for this analysis (n = 17,349) included men and women aged ≥40 years who participated in the 2007–2016 National Health and Nutrition Examination Survey. Self-reported diagnosis of HF was assessed via interview. Elevated sUA was defined as values >6.0 mg/dL for women and >7.2 mg/dL for men. Multivariable gender-stratified logistic regression was utilized to examine the odds of self-reported HF. Results: The estimated prevalence of HF was 3.9 and 3.4% among men and women, respectively. Age-adjusted analysis revealed significantly increased odds of HF in men (OR 2.79; 95% CI 2.15–3.84, p < 0.01) and women (OR 3.24; 95% CI 2.37–4.44, p < 0.01) with elevated sUA. This relationship remained statistically significant following adjustment for age, race, education, income, alcohol consumption, smoking status, blood pressure, diabetes, physical activity level, cholesterol, creatinine level, and body mass index in men (OR 1.70; 95% CI 1.13–2.57 p < 0.05) and women (OR 1.74; 95% CI 1.18–2.58, p < 0.05). Conclusions: In a representative sample of US adults, having an elevated sUA concentration was associated with significantly increased odds of HF when compared to adults with normal sUA.

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