OBJECTIVE: To determine the relationship between cardiovascular status and body fat tissue distribution in men without any premortem clinical evidence of cardiovascular disease. SUBJECTS: 30 forensic autopsy cases which consisted of sudden deaths resulting from accidental causes, suicides or homicides or from unexpected natural causes. METHODS: Body height and weight, the circumferences of the waist and hip and the thicknesses of the subscapular and abdominal subcutaneous fat were measured, and Body Mass Index (BMI) and Waist-to-Hip ratio (WHR) were calculated. Perirenal, omental and mesenterial fat deposits were weighed and supraclavicular-pericarotid and perirenal-periadrenal fat was excised and serial samples analyzed for brown adipose tissue (BAT) by computerized image analysis. The heart weight was indexed for height. The degree of coronary narrowing was determined in each artery, and myocardial collagen volume fraction and myocyte cross-sectional area were measured. RESULTS: There were significantly positive correlations between age and the degree of coronary arteriosclerosis and heart weight/height. After adjusting for age, BMI and waist circumference had a significant positive correlation with all the cardiac parameters. The degree of coronary narrowing and heart weight/height were related to tertiles of BMI and waist circumstance. The age-adjusted correlations between the subscapular fat thickness and cardiac parameters were significant and positive, and perirenal fat weight also had a significantly positive association with all the cardiac parameters. BAT decreased with age and when adjusted for age, the cervical BAT percentage had a significant negative correlation with waist circumference and WHR, and a significant negative correlation was also found between cervical BAT and the degree of coronary arteriosclerosis and between perirenal BAT and heart weight/height. CONCLUSIONS: The results suggest that body fatness is associated with coronary and myocardial pathology in men without any clinical evidence of cardiovascular disease. An abdominal accumulation of fat seems to be connected with both the severity of coronary lesions and myocardial hypertrophy in men, in whom there is also a connection between abdominal obesity and a relative scarcity of BAT. Future investigations will require more detailed analyses of the extent and ultrastructural of coronary artery lesions in order to obtain more specific information on the relationship of body fat distribution to the early asymptomatic phase of coronary disease in younger individuals.