Background: Recently, the American Heart Association developed a set of 3 ideal cardiovascular (CV) health factors. However, information on whether associations of uric acid (UA) with the CV health factors is influenced by sex, age, and body mass index (BMI) is limited. Methods: We conducted a cross-sectional analysis using a cohort of 10,420 people aged 20-100 years, who underwent health checkups in 2009. CV health factors were defined as untreated total cholesterol (TC) < 200 mg/dl, untreated systolic/diastolic blood pressure (BP) < 120/80 mm Hg, and untreated fasting plasma glucose (FPG) < 100 mg/dl. Results: The association of UA with each CV health factor was gender-specific. The interaction terms (gender x UA level) comparing change in prevalence of each CV health factor between the 1st and 4th UA quartiles showed a significantly greater reduction among women (all P < 0.01). In addition, the interactions between UA levels and age on prevalence of each CV health factor were statistically significant (all P < 0.01). Furthermore, absolute reductions in the prevalence of ideal levels of BP, and TC across ordinal UA quartiles were greater in obese individuals than in overweight and normal-weight individuals (all P < 0.01). Finally, UA showed a bell-curved relation with the prevalence of ideal FPG among all BMI categories. Conclusions: Elevated UA inversely associated with each CV health factor and these associations were influenced by gender, age and BMI. Elevated UA levels should alert clinical suspicion for a potential coexistence of low frequency of CV health factors. (C) 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.