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Background: Hyperuricemia is associated with poor cardiovascular outcomes, although it is uncertain whether this relationship is causal in nature. This study aimed to: (1) assess the heritability of serum uric acid (SUA) levels, (2) conduct a genome-wide association study on SUA levels, and (3) investigate the association between certain single-nucleotide polymorphisms and target organ damage. Methods and results: the STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Sante des Lorrains Assures Sociaux) study cohort is a single-center longitudinal cohort recruited between 1993 and 1995 (visit 1), with a last visit (visit 4 [V4]) performed approximate to 20 years apart. Serum lipid profile, SUA, urinary albumin/creatinine ratio, estimated glomerular filtration rate, 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, pulse wave velocity, and genotyping for each participant were assessed at V4. A total of 1573 participants were included at V4, among whom 1417 had available SUA data at visit 1. Genome-wide association study results highlighted multiple single-nucleotide polymorphisms on the SLC2A9 gene linked to SUA levels. Carriers of the most associated mutated SLC2A9 allele (rs16890979) had significantly lower SUA levels. Although SUA level at V4 was highly associated with diabetes, prediabetes, higher body mass index, CRP (C-reactive protein) levels, estimated glomerular filtration rate variation (visit 1-V4), carotid intima-media thickness, and pulse wave velocity, rs16890979 was only associated with higher carotid intima-media thickness. Conclusions: our findings demonstrate that rs16890979, a genetic determinant of SUA levels located on the SLC2A9 gene, is associated with carotid intima-media thickness despite significant associations between SUA levels and several clinical outcomes, thereby lending support to the hypothesis of a link between SUA and cardiovascular disease., Nancy Centre Hospitalier Regional Universitaire; French Ministry of Health; French National Research Agency (ANR); Contrat de Plan Etat?Lorraine and Fonds Européen de Développement Régional Lorraine; Programme Hospitalier de Recherche Clinique Inter regional 2013; Investissements d’Avenir; FIGHT?heart failure; French Plan d'Investissement d'Avenir project “Lorraine Université d’Excellence; European Union (EU); European Fibro?Targets Project; European HOMAGE project; 7th Framework Program; MEDIA project; FOCUS?MR; ERA?CVD EXPERT; Fondation de Recherche en Hypertension Artérielle