OBJECTIVE - This study determined whether there is a critical level of visceral adipose tissue (VAT) associated with elevated coronary heart disease (CHD) risk factors in a cohort of women >45 years of age. RESEARCH DESIGN AND METHODS - Measurements of body composition (dual-energy X-ray absorptiometry), body fat distribution (computed tomography), fasting and 2-h postprandial (75-g) glucose concentrations, and fasting lipoprotein lipid and insulin concentrations were performed in 233 perimenopausal (9%) and postmenopausal women (age 59 ± 6 years, 79% Caucasian, 16% on hormone replacement therapy). RESULTS - Women in the lowest VAT quintile (≤105 cm2) had higher concentrations of HDL and HDL2 cholesterol, lower LDL/HDL cholesterol ratios and triglyceride concentrations, and lower fasting glucose and insulin concentrations than women in the remaining four quintiles (P values <0.05-0.001). Women in the second lowest VAT quintile (106-139 cm2) had higher HDL and HDL2 cholesterol and lower LDL/HDL ratios than women with a VAT ≥163 cm2 (P < 0.05). Logistic regression analyses showed that women with a VAT of 106-162 cm2 are 2.5 times more likely to have a low HDL cholesterol (P < 0.05), while women with a VAT ≥163 cm2 are 5.5 times more likely to have a low HDL cholesterol (P < 0.01) and ∼4.0 times more likely to have a high LDL/HDL ratio (P < 0.05) compared with women with a VAT ≥105 cm2. Women with a VAT ≥163 cm2 are at a higher risk of having impaired glucose tolerance (P < 0.01). CONCLUSIONS - A VAT ≥106 cm2 is associated with an elevated risk, and a VAT ≥163 cm2 with an even greater risk, for these metabolic CHD risk factors compared with women with a VAT ≤105 cm2. These values may prove useful for defining "visceral obesity" and for identifying women most likely to benefit from preventative interventions.