In an Editorial Review in this journal in 1989, Brindley & Rolland [11 discussed possible connections between stress, diabetes and obesity, and alterations in lipoprotein metabolism predisposing to atherosclerosis. The intention of this article is to look at one aspect of these interrelationships that is attracting increasing attention, the link between insulin resistance and coronary heart disease (CHD). The hypothesis which we shall advance, that metabolic changes in adipose tissue underlie this link, is not a new one. Kissebah et al. proposed it nearly 20 years ‘ago [2, 3]. Since that time, further evidence has accrued in support of this belief. It seems an opportune time to review the evidence in favour of this hypothesis, and in addition to link it to the concept of ‘Syndrome X or ‘Reaven’s syndrome’, a group of metabolic changes associated with insulin resistance which has recently attracted considerable interest [4].