Serum urate levels have been shown to be correlated with risk for incident cardiovascular disease (CVD) events among middle-aged or older adults. However, serum urate trajectory during young adulthood and its association with CVD events has been understudied. Using serum urate measurements collected at baseline and 10, 15, 20 years after baseline from 3563 CARDIA (Coronary Artery Risk Development in Young Adults) participants (mean age 25.1±3.6 [18-30] years at baseline [year 0, 1985-1986]; 46.3% Black; 56.1% female), we determined sex-specific serum urate trajectories using SAS PROC TRAJ. We estimated hazard ratios for incident CVD events (coronary heart disease, heart failure, and stroke) occurring after the year 20 exam through 2017. We identified 3 serum urate trajectories by sex, including low-stable (n=1251), moderate-stable (n=1761), and high-increasing (n=551). Over a median 10.6 years of follow-up, 157 incident CVD events occurred. Participants among the high-increasing trajectory group had 2.89 (95% CI, 1.88-4.43) times greater risk for CVD compared with the low-stable trajectory group. The association was attenuated after adjustment for blood pressure levels during young adulthood. In conclusion, high-increasing serum urate trajectory during young adulthood was associated with incident CVD by middle age, and the association may be explained by blood pressure levels during the exposure period.