Excess visceral adipose tissue (VAT) is considered to be a primary driver for the cardiometabolic complications of obesity; VAT-associated CVD risk appears to vary by race. Mexican Americans have a disparate prevalence of metabolic disorders. This study aimed to evaluate the prevalence of excess VAT, its metabolic correlates, its association with subclinical atherosclerosis, and factors that may account for this association in Mexican Americans.Methods: In a population-based sample drawn from the Cameron County Hispanic Cohort in Texas (n=314), demographic, anthropometric, and laboratory data were obtained. Carotid intima media thickness (cIMT), an indicator of subclinical atherosclerosis, was measured by ultrasound; increased cIMT was defined as mean cIMT ≥75th percentile for age and gender. VAT was measured by dual-energy X-ray absorptiometry scan; excess VAT was defined as VAT area ≥100cm. The ratio of VAT over total body fat was also calculated (%VAT). Multivariable weighted linear and logistic regression analyses were performed to evaluate associations between VAT and cIMT.Results: Mean age was 53.2 ± 2.0 years (55.8% females). There was a high prevalence of overweight and obesity (82.3%; mean BMI 30.4 ± 0.4 kg/m), metabolic syndrome (58.6%), and excess VAT (82.3%). After adjusting for age and gender, subjects with excess VAT had higher BMI, diastolic BP, insulin, HOMA-IR, and AST, as well as thicker mean cIMT (p<0.02). Percent VAT was significantly associated with mean cIMT even after adjusting for age, gender, BMI, triglyceride level, hemoglobin A1C, and systolic BP (p=0.02; Figure).Conclusion: Excess VAT is highly prevalent in Mexican Americans and is associated with indicators of metabolic disorders, such as prediabetes and fatty liver disease. Excess VAT is also associated with early atherosclerosis regardless of BMI. Longitudinal follow up with targeted interventions to improve cardiometabolic risk may help prevent premature CVD in this underserved minority group.