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Background The role of uric acid in the development of cardiovascular disease in prehypertension is uncertain.This study examined the correlation between serum uric acid (SUA) and angiographic coronary heart disease severity in patients with prehypertension, and whether any gender differences existed.Methods Patients with prehypertension who underwent coronary angiography (n=230) were enrolled.Angiographic coronary lesion severity was diagnosed as the number of diseased vessels and coronary artery disease using the Gensini scoring system.Correlation analysis was used to determine the relationship between SUA and coronary atherosclerotic risk factors or coronary artery lesion degree, and whether any gender differences existed.Patients were divided into two groups according to coronary angiography results.Logistic regression analysis evaluated whether SUA was an independent risk factor for coronary lesions in prehypertension and any gender differences.Results Correlation analysis showed SUA was related to body mass index, smoking, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides, serum creatinine, metabolic syndrome, and severity of coronary lesions.Independently, for women, SUA was related to coronary lesion severity;the relationship was not significant for men.Logistic regression analysis showed smoking and hyperglycemia to be independent risk factors for coronary lesions in prehypertension in the population.SUA showed no independent association.Results were the same for women and men independently.Conclusions In the general population and females individually, SUA was related to risk factors and severity of coronary lesions.No independent association was found between SUA and coronary lesions in prehypertension for men and women individually.