To explore the relationship between serum uric acid and ultrafast pulse velocity (ufPWV) and its gender difference. Methods A total of 356 cases were enrolled, including 130 check-up population and 226 patients with atherosclerosis risk factors. According to the quartile of serum uric acid level of male and female respectively, the whole population was divided into Q1, Q2, Q3, and Q4 groups. The initial-systolic pulse wave velocity (PWV-BS) and end-systolic pulse wave velocity (PWV-ES) of bilateral carotid artery were measured by ufPWV. The differences of PWV-BS and PWV-ES among different serum uric acid levels and between male and female were compared. The correlation between serum uric acid and clinical data was analyzed. Logistics regression was used to analyze the relationship between serum uric acid level and high ufPWV. Results Those in the higher quartiles of serum uric acid tend to be older, had higher BMI, TC, Scr, PWV-ES and lower eGFR, HDL, had a high prevalence of hypertension. Serum uric acid, PWV-BS and PWV-ES in males were significantly higher than those in females (P＜0.001, 0.0024, 0.0018, respectively), but there was no correlation between serum uric acid and PWV-BS and PWV-ES in males, while there was a positive correlation between serum uric acid and PWV-ES in females (r=0.265, P=0.000). Serum uric acid was significantly positively correlated with BMI, TC and Scr, and negatively correlated with HDL and eGFR in both males and females, and the degree of correlation was greater in females than in males. Logistic regression shows Q1 as reference, after adjusted confounding factors such as age, BMI, SBP, DBP, TC, TG, HDL, LDL, FBG, Scr, smoking, high blood pressure, diabetes, Q4 can independently predict the risk of high PWV-ES of women (OR:5.15, 95% CI:1.20-22.10, P=0.027), and all the people (OR:2.41, 95% CI:1.42-5.69, P=0.042), but the predictive value could not be independent of eGFR. Conclusion There is a certain correlation between serum uric acid and PWV-ES, and there is a significant gender difference. Serum uric acid is an independent risk factor for female atherosclerosis, but its predictive value is dependent on eGFR to some extent.