The associations of self-reported body mass and fat distribution with self-reported prevalence rates of hypertension, heart attack, and other heart disease were examined in a sample of 40,000 women, aged 55-69 years. Fat distribution was measured by the waist-to-hip circumference ratio (WHR), which had a mean +/- SD of 0.838 +/- 0.085. Prevalence of hypertension was significantly and positively associated with both body mass index (BMI) and waist-to-hip ratio. The prevalence rate ratio for hypertension in the highest versus the lowest tertile of body mass index and waist-to-hip ratio (considered jointly) was 2.7. Prevalence rates of heart attack and other heart disease were significantly and positively associated with waist-to-hip ratio but not with body mass index. The prevalence rate ratios were 2.2 for heart attack and 1.4 for other heart disease in the highest versus the lowest tertile of body mass index and waist-to-hip ratio. Findings were substantiated using multiple logistic regression. These results support the hypothesis that a significant relationship exists between body fat distribution and the occurrence of cardiovascular disease in older women.