['Abdominal obesity and its associated metabolic consequences are major determinants for the development of vascular disease. Fat tissue close to arteries may also directly affect atherogenesis. The study examined whether intra-abdominal fat accumulation is an independent determinant of infrarenal aortic diameter in patients with clinically evident arterial disease. The relationship between metabolic syndrome and infrarenal aortic diameter was also assessed in this patient group.', 'Cross-sectional study was done of 2726 patients with clinically evident arterial disease enrolled in the Second Manifestations of ARTerial Disease (SMART) study. Intra-abdominal fat was measured with ultrasonography and by measuring waist circumference. Metabolic syndrome was defined according to the Adult Treatment Panel III. The maximal anteroposterior diameter of the infrarenal aorta was measured using ultrasonography. The relation between intra-abdominal fat, metabolic syndrome, and infrarenal aortic diameter was determined with linear regression analyses and adjusted for age, sex, height, and smoking.', 'Infrarenal aortic diameters (mm) increased across quartiles of intra-abdominal fat derived by ultrasonography (quartile 4, 19 +/- 7 mm vs quartile 1, 17 +/- 5 mm; adjusted beta, 1.34; 95% confidence interval [CI], 0.73-1.94) and across quartiles of waist circumference (quartile 4, 19 +/- 7 mm vs quartile 1, 17 +/- 5 mm; adjusted beta, 1.43; 95% CI, 0.82-2.04). Patients with metabolic syndrome had slightly larger infrarenal aortic diameters (18 +/- 7 mm vs 17 +/- 6 mm; adjusted beta, 0.70; 95% CI, 0.27-1.13) compared with those without metabolic syndrome.'] Are intra-abdominal fat and metabolic syndrome associated with larger infrarenal aortic diameters in patients with clinically evident arterial disease?