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Background: Men with gout have been found to have an increased risk of acute myocardial infarction (AMI), but no corresponding data are available among women., Objective: To evaluate the potential independent association between gout and the risk of AMI among elderly women, aged > or = 65 years., Methods: A population-based cohort study was conducted using the British Columbia Linked Health Database and compared incidence rates of AMI between 9642 gout patients and 48 210 controls, with no history of ischaemic heart disease. Cox proportional hazards models stratified by gender were used to estimate the relative risk (RR) for AMI, adjusting for age, comorbidities and prescription drug use., Results: Over a 7-year median follow-up, 3268 incident AMI cases, were identified, 996 among women. Compared with women without gout, the multivariate RRs among women with gout were 1.39 (95% CI 1.20 to 1.61) for all AMI and 1.41 (95% CI 1.19 to 1.67) for non-fatal AMI. These RRs were significantly larger than those among men (multivariate RRs for all AMI and non-fatal AMI, 1.11 and 1.11; p values for interaction, 0.003 and 0.005, respectively)., Conclusion: These population-based data suggest that women with gout have an increased risk for AMI and the magnitude of excess risk is higher than in men.