In a cross-sectional study of 226 patients (160 men and 66 women) who underwent coronary angiography, the relationships between total body fatness and abdominal fat distribution, and angiographically assessed coronary artery disease (CAD) were examined. Two different scoring systems were used to quantify the degree of CAD: an 'extent score' and a 'myocardial score'. The extent score provides an estimate of the extent of coronary atherosclerosis and the myocardial score provides an assessment of the amount of myocardium threatened by coronary lesions. Total body fatness was estimated using the body mass index (BMI) and the waist-to-hip circumference ratio (WHR) was used to assess abdominal fat distribution. The weight and height were obtained by questionnaire at the time of angiography, and self-reported waist and hip circumference measurements were used to calculate WHR. The BMI and WHR were associated with several coronary heart disease (CHD) risk factors. However, BMI was not significantly associated with either of the CAD scores. The WHR was positively associated with both the extent score (rs = 0.18; P < 0.05) and the myocardial score (rs = 0.17; P < 0.05) for men and women together, and positively associated with the myocardial score for women aged 40 to 70 years (rs = 0.32; P < 0.05). The associations between WHR and the CAD scores were not significant after adjusting for several risk factors for CHD. These results indicate that other risk factors for CHD may be involved in the associations between WHR and CAD.