Waist circumference 'action levels' have been recommended as a screening tool for overweight/obesity and associated metabolic risk factors. The use of waist circumference action levels in identifying need for weight management and higher metabolic risk was evaluated in 541 consecutive coronary artery disease patient referrals (85 female) to a long-term maintenance, community-based cardiac rehabilitation programme. Recommended waist circumference action levels identified overweight and obese patients (body mass index (BMI ≥ 25.0 kg·m -2 and ≥ 30.0 kg·m -2, respectively) and those with lower BMI but abdominal adiposity (waist:hip ratio ≥ 0.95 males, ≥ 0.80 females) with high sensitivity values. The prevalence of several metabolic risk factors was different between male and female patients in this cohort. Male patients exceeding the lower waist circumference action level (≥ 94 cm) showed significantly increased odds ratios for hypertriglyceridemia; those at the higher action level (≥ 102 cm) additionally exhibiting low high density lipoprotein cholesterol, a raised TC:HDL-C ratio and diastolic hypertension. Male subjects with increased waist circumferences were also 2-3 times as likely to have multiple (≥ 3) metabolic risk factors. Higher odds ratios were evident only for hypertriglyceridemia in female patients above the higher action level (≥ 88 cm). Waist circumference action levels (94 cm and 102 cm in males; 80 and 88 in females) may be utilized in secondary prevention settings to identify subjects requiring weight management. Furthermore, waist circumferences higher than the recommended action levels may also indicate increased metabolic risk despite standard cardioprotective drug therapy.