Background and purpose: The long-term effect of gout on the risk of acute myocardial infarction (AMI) in young adults is unknown. This nationwide cohort study aimed to in-vestigate the independent association between gout and the incidence of AMI, especially in patients younger than 40 years. Methods: We retrospectively obtained data of 60,997 pa-tients (683,652 person-years) diagnosed with gout in 2002 from the Longitudinal Health Insurance Database, Taiwan. All participants were followed up from the date of enrollment until AMI or the end of data collection in 2013, whichever occurred first. Multivariate Cox proportional hazards models and Nelson-Aalen cumulative hazard function were used to evaluate the risk of AMI in patients with gout. Results: The incidence of AMI was 3.80 and 1.01 per 1000 person-years in patients with and individuals without gout, respectively. After adjustment for demographics and comorbidities, individuals with gout had a higher overall risk of AMI (hazard ratio, HR=1.21, 95% confidence interval, CI=1.15-1.26), and this finding was noted in men (HR=1.25, 95% CI=1.19-1.31) and women (HR=1.19, 95% CI=1.09-1.30). Gout in adults aged 20-39 years had a higher independent effect on AMI in men (HR=1.92, 95% CI=1.54-2.39) than in women (HR=1.34, 95% CI=0.48-3.70). Con-clusion: Our study reveals that gout is a risk factor for AMI, particularly in adults younger than 40 years. Given the potential long-term complications of AMI among young patients, as well as their families and society, the results of this study may contribute to the devel-opment of early pharmacological interventions to prevent AMI.