Catechol-O-methyltransferase (COMT) is an enzyme that catalyses the methylation of catechol substrates, classically in catecholamine metabolism, but also acting upon other substrates such as oestrogen and polyphenols. Although its classical function has been established for more than five decades, an ever expanding COMT role in other pathways and diseases has become a subject of active study in recent years. The most highlighted domains are related with COMT involvement in neuropsychiatric disorders and its role in the neurobiology of cognition, behaviour, emotions, pain processing and perception, sleep regulation, addictive behaviour and neurodegeneration. Nonetheless, great attention is also being devoted to a possible COMT contribution to the development of cardiovascular disorders and hormonally influenced diseases, including cancer. This review aims to update the role of COMT function and its involvement in cardiovascular and neurological disorders.