BACKGROUND: Although there are increasing evidences that serum urate is an independent marker of cardiovascular diseases and stroke, the issue remain unresolved. And there have been few studies of the effect of serum urate on the risk of cardiovascular events in patients with acute stroke. We sought, in patients with a diagnosis of acute stroke, to explore the association between serum urate levels and any predictive role in acute cardiovascular events such as ischemic heart disease (IHD) and congestive heart failure (CHF) after acute stroke. METHODS and METERIALS: Between August 2006 and May 2009, Serum urate concentration was measured in 620 acute stroke patients. Patients were divided into 2 groups according to the serum urate levels. IHD, CHF, mortality from all causes, and other clinical characteristic data were compared between both groups. RESULTS: In this retrospective study, 620 acute stroke patients (330 men, mean age 65 짹 13 years) were included. We divided the patients into those with normal serum urate level (<6.9 mg/dL) group (n=569, mean=4.6 짹 1.3 mg/dL) and high serum urate level (���6.9 mg/dL) group (n=51, mean=8.6 짹 1.7 mg/dL). IHD occurred in 6 (11.8%) of patients with high serum urate level group and in 10 (1.8%) of patients with normal serum urate level group (p=0.001). CHF occurred in 6 (11.8%) of patients with high serum urate level group and in 6 (1.1%) of patients with normal serum urate level group (p=0.001). On univariate analysis, diabetes mellitus, hypertension, serum urate, left ventricular ejection fraction (LVEF) at presentation had statistical significance for IHD in these groups (p < 0.05). On univariate analysis, serum urate, left ventricular ejection fraction at presentation had statistical significance for CHF in these groups (p < 0.05). On multivariate analysis, only serum urate level was an independent predictor for IHD [Hazard Ratio (HR) 7.708, 95% Confidence Interval (CI) 1.934-30.720, p = 0.004] and CHF (HR 11.849, 95% CI 2.152-65.237, p = 0.005). And, there was no statistical significance for death between both groups. CONSLUSIONS: These results suggest that high serum urate level have independent predictive role in IHD and CHF after acute stroke. In routine practice, serum urate levels could be useful for identifying risk of acute cardiovascular events in acute stroke patients.