Context:Regional fat distribution rather than overall obesity has been recognized as important to understanding the link between obesity and cardiovascular disease.Objective:We examined the associations of abdominal visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiovascular risk factors in a Caucasian population of men and women with normal glucose tolerance, prediabetes, or screen-detected diabetes.Design, Setting, and Participants:The study was based on cross-sectional analysis of data from 1412 adults age 45–80 years. VAT and SAT were assessed by ultrasound. The associations of VAT and SAT with blood pressure and lipids were examined by linear regression analysis adjusted for age, sex, smoking, alcohol, physical activity, glucose tolerance status (GTS), medication use, and body mass index. Effect modification by GTS and sex was examined, and stratified analyses performed.Results:Independent of SAT and overall obesity, VAT was associated with higher triglyceride and lower high-density lipoprotein (HDL) cholesterol levels in both men and women and additionally associated with higher total cholesterol in men. SAT was independently associated with higher total cholesterol and low-density lipoprotein cholesterol levels in both sexes, and SAT was additionally associated with higher triglyceride and lower HDL cholesterol levels in women and with higher blood pressure in participants with diabetes.Conclusion:Both abdominal VAT and SAT are independent of overall obesity associated with cardiovascular risk in a population of men and women at low to high risk of diabetes or with screen-detected diabetes.