Background: Uric acid and high density lipoprotein cholesterol are both considered as risk factors of cardiovascular mortality. The ratio of uric acid to high density lipoprotein cholesterol (UH ratio) has been reported to be a good predictor of cardiovascular events. However, few studies have examined UH ratio and cardiovascular function in overweight/obese children. The purpose of this study is to assess the relationship between UH ratio and cardiovascular function in children. Methods: Echocardiography was performed in 453 children aged 7 to 15 years (body mass index 18 to 34 kg/m 2 ). Stroke volume (SV) was measured using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance was estimated by end-systolic pressure/SVI. End-systolic elastance was calculated by a modified single-beat method. Lipids, uric acid, fasting glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), and high sensitive C-reactive protein (hs-CRP) were also assessed. Results: Effective arterial elastance and end-systolic elastance increased significantly with body mass index (r = 0.35 and 0.22, p < 0.01, respectively). There were significant relationships between body mass index and UH ratio, HOMA-IR, high density lipoprotein cholesterol, uric acid, triglycerides, and hs-CRP (r = 0.53, 0.52, -0.32, 0.46, 0.37, and 0.38, p < 0.01, respectively). Effective arterial elastance correlated significantly with UH ratio, HOMA-IR, uric acid, high density lipoprotein cholesterol, triglycerides, and hs-CRP (r = 0.24, 0.20, 0.18, -0.11, 0.21, and 0.18, p < 0.05, respectively). There were significant relationships between end-systolic elastance and UH ratio, HOMA-IR, uric acid, and triglycerides (r = 0.25, 0.16, 0.15, and 0.11, p < 0.05, respectively). In multiple regression analysis, UH ratio was independent determinants of effective arterial elastance and end-systolic elastance. Conclusions: The present study demonstrates that UH ratio is a useful indicator reflecting cardiometabolic risk in obese children. Higher UH ratio and combined arterial-ventricular stiffening may contribute to the increased prevalence of later cardiovascular disorder.