Context: Individual contributions of obesity and physical fitness (physical ac tivity and functional capacity) to risk of coronary heart disease in women remai n unclear. Objective: To investigate the relationships of measures of obesity (b ody mass index [BMI], waist circumference, waist hip ratio, and waist height r atio) and physical fitness (self reported Duke Activity Status Index [DASI] a nd Postmenopausal Estrogen Progestin Intervention questionnaire [PEPI Q] score s) with coronary artery disease (CAD) risk factors, angiographic CAD, and adverse cardiovascular (CV) events in women evaluated for suspected myocardial ischemia. Design, Setting, and Participants: The National Heart, Lung, and Blood Institut e sponsored Womens Ischemia Syndrome Evaluation (WISE) is a multicenter prosp ective cohort study. From 1996-2000,936 women were enrolled at 4 US academic me dical centers at the time of clinically indicated coronary angiography and then assessed (mean follow up, 3.9 [SD,1.8] years) for adverse outcomes. Main Outc om e Measures: Prevalence of obstructive CAD (any angiographic stenosis ≥50%) and incidence of adverse CV events (all cause death or hospitalization for nonfata l myocardial infarction, stroke, congestive heart failure, unstable angina, or o ther vascular events) during follow up. Results: Of 906 women (mean age, 58 [S D , 12] years) with complete data, 19%were of nonwhite race, 76%were overweight (BMI ≥25), 70%had low functional capacity (DASI scores <25, equivalent to ≤7 metabolic equivalents [METs]), and 39%had obstructive CAD. During follow up, 3 37 (38%)-women had a first adverse event, 118(13%) had a major adverse event, and 68 (8%) died. Overweight women were more likely than normal weight women t o have CAD risk factors, but neither BMI nor abdominal obesity measures were sig nificantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors (P=.05 to .88). Conversely, women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD (44 %vs 26%, P<.001) at baseline, and each 1-MET increase in DASI score was indep endently associated with an 8%(hazard ratio, 0.92; 95%confidence interval, 0.8 5-0.99; P=.02) decrease in risk of major adverse CV events during follow up. C onclusions: Among women undergoing coronary angiography for suspected ischemia, higher self reported physical fitness scores were independently associated with fewer CAD risk factors, less angiographic CAD, and lower risk for adverse CV ev ents. Measures of obesity were not independently associated with these outcomes. Context: Individual contributions of obesity and physical fitness (physical ac tivity and functional capacity) to risk of coronary heart disease in women remai n unclear. Objective: To investigate the relationships of measures of obesity (b ody mass index [BMI], waist circumference , waist hip ratio, and waist height r atio) and physical fitness (self reported Duke Activity Status Index [DASI] a nd Postmenopausal Estrogen Progestin Intervention questionnaire [PEPI Q] score s) with coronary artery disease (CAD) risk factors, angiographic CAD , and adverse cardiovascular (CV) events in women evaluated for suspected myocardial ischemia. Design, Setting, and Participants: The National Heart, Lung, and Blood Institut e sponsored Women’s Ischemia Syndrome Evaluation (WISE) is a multicenter prosp ective cohort study From 1996-2000,936 women were enrolled at 4 US academic me dical centers at the time of clinically indicated coronary angiography and then assessed (mean follow up, 3.9 [SD, 1.8] years) for adverse outcomes. Main Outcome Measures: Prevalence of obstructive CAD (any angiographic stenosis ≥ 50%) and incidence of adverse CV events (all cause death or hospitalization for nonfata l myocardial infarction, stroke, congestive heart failure, unstable angina Results: Of 906 women (mean age, 58 [SD, 12] years) with complete data, 19% of nonwhite race, 76% were overweight (BMI ≥ 25), 70 % had low functional capacity (DASI scores <25, equivalent to ≤7 metabolic equivalents [METs]), and 39% had obstructive CAD. During follow up, 37 37 (38%) - women had a first adverse event, Overweight women were more likely than normal weight women to have CAD risk factors, but neither BMI nor abdominal obesity measures were sig nificantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors (P = .05 to .88). Conversely, women with lower DASI scores were significantly likely to have CAD risk factors and obstructive CAD (44% vs 26%, P <.001) at baseline, and each 1-MET increase in DASI score was independents associated with an 8% hazard ratio (0.92; 95 % confidence interval, 0.8 5-0.99; P = .02) decrease in risk of major adverse CV events during follow up. C onclusions: Among women undergoing coronary angiography for suspected ischemia, higher self reported physical fitness scores were minor associated with fewer CAD Risk factors, less angiographic CAD, and lower risk for adverse CV ev ents. Measures of obesity were not independently associated with these outcomes.