Background: Body fat distribution (BFD) especially visceral fat accumulation is closely related to cardiovascular disease than the amount of total body fat itself. We studied the relationship of BFD to the extent of coronary atherosclerosis. Methods: We measured total body fat and regional body fat distribution using dual-energy X-ray absorptiometery in 417 patients (217 male, age 59짹11 years) who underwent their first coronary angiography. The extent of coronary atherosclerosis was assessed using a coronary atherosclerosis score (CAS) based on the quantitative coronary angiography results. The coronary artery tree was divided into 9 segments and each of these segments was scored from 0 to 3 depending on the most severe stenosis using the following system: 0 = normal, 1 = stenosis between 1% and 49%, 2 = stenosis between 50% and 99%, and 3 = total occlusion. A CAS was generated as the sum of the scores in all segments. Results: Mean CAS of the enrolled patients was 3.3짹3.5. Percentage truncal fat mass to total body fat mass ratio (%FM_trunk/FM_total) and percentage truncal fat mass to extremities fat mass ratio (%FM_trunk/FM_ext) revealed positive correlation with CAS (r= 0.245, p<0.001; r= 0.214, p<0.001, respectively). In contrast, body mass index and total body fat mass did not correlate with CAS (r= 0.055, p=0.255;r= -0.005, p=0.927, respectively). %FM_trunk/FM_total was independently associated with CAS on multiple logistic analysis (棺=0.123; 95% CI, 0.009 to 0.140, p=0.026). Conclusions: BFD, especially %FM_trunk/FM_total representing central fat distribution is closely related to the extent of coronary atherosclerosis. More active therapeutic interventions for central fat accumulation might be essential to prevent coronary atherosclerosis.