Glucose intolerance is associated with increased risk of coronary heart disease (CHD) in Japanese-Americans, especially in men. Intra-abdominal fat, assessed by computed tomography, is increased in those with both NIDDM and CHD. Increased intra-abdominal fat (visceral adiposity) with CHD is independent of NIDDM or impaired glucose tolerance. The association between NIDDM and CHD may be explained by the association of each of these conditions with visceral adiposity. However, hyperinsulinemia is associated with CHD only in the presence of diabetes, whereas triglyceride levels are elevated with CHD independent of glucose tolerance category. These findings suggest that factors other than insulin levels, such as lipids, may mediate the relationship between visceral adiposity and CHD. Moreover, these relationships are influenced by gender.