The role of hyperuricaemia as an independent cardiovascular risk factor remains controversial and subject to debate. Nonetheless, multiple studies have highlighted the central role of uric acid (UA) in conditions such as hypertension, metabolic syndrome, heart failure and coronary artery disease. Various mechanisms have been proposed to explain UA's involvement in cardiovascular diseases, including through UA-induced oxidative stress, systemic inflammation, endothelial dysfunction and activation of the renin-angiotensin-aldosterone system (RAAS). Asymptomatic hyperuricaemia has been proposed as an independent risk factor for ischaemic heart disease. Nonetheless, the positive impact of urate-lowering therapies on reducing cardiovascular risk still needs to be thoroughly confirmed through large randomised controlled studies.