BACKGROUND: We aimed to determine which index of obesity is the best discriminator of cardiovascular (CV) risk in Korean type 2 diabetes (T2DM) patients. METHODS: This is a cross-sectional study involving 1,111 T2DM patients from two university hospitals. We measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and biochemical CV risk factors in all subjects. The 10-year coronary heart disease risk was calculated with the Framingham Risk Score. RESULTS: BMI showed significant correlation with SBP (systolic blood pressure), DBP (diastolic blood pressure), TC (total cholesterol), TG (triglyceride), HDL-C, and LDL-C. WC showed significant correlation to SBP, DBP, homocysteine, TG and HDL-C. WHR was significantly associated with SBP, DBP, TG, HDL and microalbuminuria. WHtR was significantly correlated to SBP, TG, HDL-C and LDL-C. WC (P < or = 0.001, P for trend < or = 0.001), WHR (P = 0.002, P for trend < or = 0.001) and WHtR (P = 0.001, P for trend < or = 0.001), except for BMI (P = 0.628, P for trend = 0.258), showed significant differences according to increasing quintiles of Framingham Risk Score. CONCLUSION: WC, WHR and WHtR were more closely related to CV risk score than BMI in Korean T2DM patients.