 Uric acid UA is a terminal product of purine metabolism with strong antioxidant properties. UA has sizeable concentrations in biologic fluids only in humans and primates because they have a non-functional mutation of the enzyme uricase that, in other animals, transforms UA to allantoin. It has been hypothesized that this mutation has emerged evolutionarily because through this mechanism, humans can counteract the excessive oxidative stress that occurs in many critical pathologic conditions. Partially in contrast with this theory, high levels of UA have been associated with a number of negative health outcomes, including cardiovascular as well as all-cause mortality. Although it is possible that the UA elevation is merely a marker of critical health because it is an inducible antioxidant, researchers have questioned whether UA has beneficial or detrimental effect on health status. For example, we recently demonstrated that higher UA levels are cross-sectionally associated with higher levels of pro-inflammatory markers, and predict the increase in inflammatory markers over a 3-year follow-up. Understanding whether UA exerts a protective or detrimental effect on health is important in deciding whether mild hyperuricemia should or should not be aggressively treated. 