Cross-sectional studies have shown that a central distribution of adipose tissue is associated with increased risk of metabolic complications and cardiovascular morbidity. Four prospective studies in men are reviewed and they consistently indicate that central adipose tissue distribution is a risk factor for coronary heart disease (CHD) and its predictive contribution seems almost to be in the same order as for the major risk factors for CHD. In one study there is an indication of decreasing predictive power of central adipose tissue distribution for CHD with increasing age. Abdominal adipose tissue distribution is also a risk factor for stroke, diabetes and sickness absenteeism, and for all cause mortality. It seems, however, not to be a predictor of degree of well-being in general. The question of causality is not solved but indices of adipose tissue distribution should be included in future observational and experimental studies in this field.