Despite being used for a long time as food and beverage by Brazilian people who live on the Amazon bay, only in the beginning of this century, açaí berries have been the object of scientific research. Açaí berries are rich in polyphenols that probably explains its versatile pharmacological actions and huge consumption, not only in Brazil but also in Europe and United States. In this review, not all but some pharmacological aspects of açaí berries are analyzed. Chemical and pharmacological differences between extracts obtained from the skin and seed of açaí are considered. Polyphenols from the seed of açaí increase endothelial nitric oxide production leading to endothelium-dependent relaxation, reduce reactive oxygen species and regulate key targets associated with lipid metabolism in different conditions such as hypertension, renal failure, and metabolic syndrome. We review the novel mechanisms of actions of açaí on different targets which could trigger the health benefits of açaí such as antioxidant, vasodilator, antihypertensive, cardioprotector, renal protector, antidyslipidemic, antiobesity, and antidiabetic effects in cardiovascular and metabolic disturbances.