OBJECTIVE: The purpose of this study was to evaluate the associations of BMI versus metabolic syndrome with cardiovascular diseases (CVDs) in elderly Chinese individuals. RESEARCH DESIGN AND METHODS: We conducted a population-based cross-sectional study in an urban sample of 2,334 elderly subjects (943 men and 1,391 women). Subjects were classified by BMI (< or = 18.5, < 24, < 28, and > or = 28 kg/m2) and the presence or absence of metabolic syndrome, which was defined by International Diabetes Federation (IDF) criteria. CVDs included clinically diagnosed coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD). RESULTS: The prevalence rates of overweight (BMI > or = 25 kg/m2) and metabolic syndrome according to the IDF criteria were 56.3% (53.9% in men and 57.9% in women) and 46.3% (34.8% in men and 54.1% in women), respectively. Increasing BMI was strongly associated with a higher risk of CHD, stroke, and PAD even after adjustments for metabolic syndrome and other CVD risk factors. Stratified analysis of participants with or without metabolic syndrome showed that BMI was independently associated with CHD, stroke, and PAD. CONCLUSIONS: Both overweight and metabolic syndrome are highly prevalent in this elderly Chinese population. BMI, as a measure of overall adiposity, is strongly associated with increased prevalence of CVD independent of metabolic syndrome.