Uric acid has long been associated with cardiovascular disease. Most epidemiological evidence suggests a significant, graded, independent and specific association between the level of serum uric acid and cardiovascular morbidity and mortality. This is particularly robust among persons at high cardiovascular risk, including those with hypertension, diabetes and congestive heart failure. Although several potential mechanisms have been identified to explain this association, as yet there is no evidence that uric acid bears a causal or reversible relationship to vascular disease.