PURPOSE OF REVIEW: The systematic study of gout dates to antiquity, to Hippocrates' initial descriptions of disease risk factors including advancing age, female menopause, and male sex. Although urate crystal diagnosis remains the gold standard for diagnosis it is impractical at a population level. Beyond crystal diagnosis, progress in gout epidemiology has been hampered by the lack of a standardized approach in defining case status. RECENT FINDINGS: Substantial progress has been made in furthering our understanding of gout over the last few decades. Taken together, epidemiologic investigations suggest that gout frequency is on the rise worldwide. Our understanding of gout risk factors continues to expand with the recent availability of well designed prospective cohort studies from both the USA and abroad. Moreover, recent investigations have shed important insight on the complex relationships of hyperuricemia, gout, and comorbid conditions, particularly the association of serum urate levels with cardiovascular morbidity and mortality. SUMMARY: Despite our growing understanding of the many facets of this age-old condition, current evidence continues to underscore the frequency with which gout is characterized by suboptimal care. Below we review our current knowledge of gout epidemiology with an emphasis on the association of hyperuricemia with cardiovascular comorbidity and evidence and determinants of continued suboptimal care in gout.