Background Obese individuals are likely to have a high burden of subclinical disease and at increased risk of development of overt cardiovascular disease (CVD). We were to determine the relationships between abdominal obesity, other metabolic risk factors, and left ventricular hypertrophy (LVH) in healthy middle aged and older men without clinical CVD. Methods and Results Healthy 251 men who visited for a general health examination and free from overt medical illness were enrolled. Sixty-five men (25.9%) with abdominal obesity, defined by waist circumference (WC) ���90 cm, were compared with 186 men with WC <90 cm. Men with increased WC had more increased prevalence of traditional risk factors, insulin resistance, and metabolic syndrome and more decreased insulin sensitivity. WC increased substantially as the numbers of elements of metabolic syndrome. Men with increased WC had higher Cornell voltage, and Cornell voltage product than men with WC<90cm. Conclusions The metabolic risk factors and LVH are prevalent in healthy middle-aged and older men with abdominal obesity. Thus routine measurement of WC defining abdominal obesity may reflect subclinical CVD and predict obesity-related health risk.