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Objectives To assess the association between UA level and the prevalence, severity, plaque characteristics and calcium score(CACS) of coronary atherosclerosis in patients with suspected coronary artery disease undergoing 256-detector coronary computed tomography, and further assess in sex subgroup.Methods A total of 1116 individuals with suspected CAD without known CAD were successful enrolled.The individuals were stratified into four groups according to their serum UA quartile in total, male and female, respectively.The baseline demographic and clinical characteristics of all population were collected, the prevalence, severity, characteristics and CACS of plaque were analysed by CCTA.The association the quartile of UA with the prevalence, severity, characteristics and CACS of plaque were assessed in total, male and female.The univariable and multivariable logistic regression were employ to find the association UA with significant stenosis, multivessel disease, high CACS and plaque characteristics in total, male and female, respectively.Results Among the study individuals, 50.7% were men, the mean age was 58.05±10.69 years.With increase in quartiles UA, the prevalence of anyplaque in total and female sifgnificantly increased (Total: p<0.001; Female: p=0.002); the prevalence of significant stenosis in total and female significantly increased (Total: p<0.001; Female: p=0.010); the prevalence of severe stenosis in total and female sifgnificantly increased(Total: p=0.001; Female: p=0.032).The incidence of double-vessel lesion only significantly increased with UA in female (p=0.017).In the total and female, the proportions of triplevessel/left main artery lesion were highest in the fourth quartile (Total: p<0.001; Female: p=0.027).The prevalence of CACS=0 decreased significantly as the quartiles of UA increases in total, male and female, the proportions of CACS=0 in total, male and female at each UA quartiles were highest in the first quartile, and lowest in the fourth quartile (Total: p<0.001; Male: p=0.006; Female: p<0.001, respectively).When the analyses were made in CACS>10, increasing quartiles of UA were significantly associated with CACS>10 in both total (p=0.001) and female (p=0.002).As the UA increases in female, the proportion of mixed plaques increased significantly(p=0.022).After adjusting for other risk factors, UA was the significant predictor of significant stenosis(OR:1.004, 95%CI(1.001-1.007), P=0.011), multivessel disease(OR:1.003, 95%C.I(1.001-1.006), P<0.001) and mixed plaque (OR:1.003, 95%C1(1.001-1.006), P=0.015) in female subgroup; in total population, UA was only the strongest risk factor for mixed plaque(OR:1.002, 95%CI (1.001-1.003), P=0.046).Conclusion UA was the significant predictor of significant stenosis, multivessel disease and mixed plaque in female subgroup; The level of UA was significantly associated with coronary atherosclerosis of female, but not male.