Many large epidemiological studies confirmed a positive association between raised serum uric acid (SUA) levels and risk of coronary heart disease (CHD) or cardiovascular disease (CVD) in the general population, among hypertensive patients and those with established CHD, stroke, diabetes and heart failure. There is much controversy concerning the role of SUA as an independent risk factor for CHD as SUA is related to many of the established risk factors for cardiovascular disease including hypertension, dyslipidaemia, obesity and pre-existing disease. The epidemiological evidence suggests that SUA is an independent predictor of CVD in subjects with hypertension and established vascular disease but not in healthy subjects. This evidence suggests that the influence of SUA on CHD is explained by the secondary association of SUA with other established etiological risk factors (hypertension, dyslipidaemia, hyperinsulinaemia, obesity and pre-existing disease). There is no evidence so far to indicate that lowering SUA levels with drug treatment has a beneficial effect on CVD outcome. In summary, there is little support for an independent causal role for SUA in the development of CHD. However, SUA may provide useful prognostic information in subjects with hypertension and vascular disease.