Various epidemiologic studies have linked an increase in serum uric acid level to an increased risk of coronary heart disease. The reasons for this finding are unclear. The authors examined the influence of a number of cardiovascular disease risk factors on serum uric acid level in 886 middle-aged and older men participating in the Normative Aging Study. The men were examined between 1987 and 1991. In a multivariate regression model predicting serum uric acid level, uric acid was positively associated with body mass index (weight (kg)/height (m)2 beta = 0.041 mg/dl per kg/m2, p = 0.003), abdomen: hip circumference ratio (beta = 1.88 mg/dl per cm/cm, p = 0.048), log alcohol intake (beta = 0.150 mg/dl per g/week, p = 0.0001), and log postcarbohydrate insulin level (beta = 0.157 mg/dl per log(microIU/ml), p = 0.005). Serum uric acid level was negatively associated with age (beta = -0.012 mg/dl per year of age, p = 0.017) and log physical activity (beta = -0.152 mg/dl per kcal/week, p = 0.0001). The data suggest that serum uric acid may be involved in the obesity-insulin resistance syndrome, which in turn may explain the relation of serum uric acid to coronary atherosclerosis.