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Objective: To identify SUA level trajectories throughout 12 years and to examine their associations with incident diabetes and hypertension among middle-aged men and women.Methods: A total of 7187 participants from the Mudanjiang Chronic Non-communicable Diseases Study, who were aged 30-60 years and without diabetes or hypertension at baseline, were included. The participants were followed for an average of 10.5 years by annual examinations. Latent mixture modeling was used to identify trajectories of SUA over time.Results: Consistently among women and men, five distinct trajectories of SUA were identified: low-stable, low-increasing, moderate-stable, moderate-increasing, and high-stable. In multivariate models, compared with low-stable group, for women, the adjusted hazards ratio of diabetes was 2.11 (95%CI 1.08-4.23) in the low-increasing group, 1.78 (0.81-3.92) in the moderate-stable group, 2.01 (1.02-3.97) in the moderate-increasing group, 3.00 (1.55-5.83) in the high-stable group, whereas no association was found among men. In addition, compared with low-stable group, all other trajectory groups had an increased risk of hypertension in both men and women, except for moderate-stable group in women. Participants in the moderate-increasing group exhibited the highest risk of hypertension (for women, 2.42 [1.72-3.39], for men, 2.57 [2.05-3.24]). Further adjustment for weight change during follow-up period completely ablated the trajectories-diabetes associations, except for the high-stable group in women, but the trajectories-hypertension associations remained significant in each group.Conclusions: We found that a persistent elevated or an increasing trend of SUA levels was significant associated with an increased risk of hypertension among middle-aged women and men; only persistently high UA level was associated with diabetes among women.