PURPOSE: To determine whether baseline serum uric acid (UA) levels and estrogen-progestin (E + P)-associated change in serum UA in postmenopausal women with coronary disease are associated with recurrent coronary heart disease (CHD) events. METHODS: 2763 postmenopausal women enrolled in the Heart and Estrogen-Progestin Replacement Study (HERS) were randomly assigned to take conjugated E + P or placebo in a secondary CHD prevention study. The primary outcome for these analyses was nonfatal myocardial infarction or CHD death during a mean follow up of 4.1 years. RESULTS: The baseline serum UA for the cohort was 5.4 mg/dl and, compared with placebo, E + P on average lowered serum UA levels slightly (0.2 mg/dl) at one year of follow up (p <0.0001). Baseline serum UA levels were associated in simple proportional hazards models with CHD events; each standard deviation increase (1.3 mg/dl) was associated with a 22% increased risk of primary CHD events (p = .0001). This association, however, was no longer statistically significant after multivariable adjustment (p = 0.36). There was no association between on-study change in serum UA level and any CHD outcome. CONCLUSION: Treatment with E + P lowered serum UA levels slightly, but neither baseline UA nor change in UA affected CHD risk. © 2006 Elsevier Inc. All rights reserved.