A number of epidemiological studies and clinical trials had shown that hyperuricemia was an independent risk factor for morbidity and unfavorable prognosis of coronary heart diseases, and it also might contribute to the incidence and development of coronary atherosclerosis (AS); and thus, uric acid lowering drugs had anti-ischemic effects in myocardial ischemia. Therefore, treating hyperuricemia would be a new target to prevent coronary AS. However, some other studies had obtained different conclusions revealing there was no correlation between hyperuricemia and coronary heart disease. Thus, pathogenicity of uric acid was still lack of evidence. Meanwhile, high levels of uric acid were found in atherosclerosis plaque in pathological studies. In some in vitro studies, uric acid induced reactive oxygen species production in endothelial cells and vascular smooth muscle cells (VSMCs), which led to endothelial dysfunction and proliferation of VSMCs, and contributed to the formation of AS. However, uric acid was also proved as antioxidant in some other studies. Therefore, the relationship between hyperuricemia and coronary heart disease was still controversial.