Obesity is a well-known risk factor in cardiovascular disease development especially in cases with central distribution of fat tissue. Research is mainly focused on visceral fat tissue characteristics, but visceral fat role in cardiovascular disease has yet to be established. In modern era, cardiac imaging methods reveals fat tissue depots, which can influence the work of central organs locally: epicardial fat with influence on the heart, perivascular fat and vascular structures. Mechanisms linking fat distribution and cardiovascular risk are complex and includes: fat and glucose metabolism changes, influence on risk factors (hypertension, inflammation), systemic and local adipokine action. Epicardial fat is a visceral fat tissue depot directly linked to myocardial tissue through conjucted microcirculation and is metabolically active. Recent literature is focused on balancing proatherosclerotic - inflammatory and protective activity of fat tissue. Mazurek et al showed a study on 42 patients referred to coronary artery bypass grafting in which proinflammatory cytokines concentration in epicardial and subcutaneous fat tissue was measured with PCR and ELISA method. They found higher concentrations of proinflammatory adipokines in epicardial fat tissue. Well known Framingham Heart Study on more than 1000 pts revealed liaison of epicardial fat tissue volume and calcium scoring in coronary arteries. Meta-analysis of 9 studies with 3992 pats showed good correlation of high-risk plaques in coronary arteries and fat tissue volume. Quantification of epicardial fat tissue volumes could be implemented in cardiovascular risk stratification. Study published in JACC by Mahabadi et al included 4093 pts and showed good correlation of epicardial fat tissue volume and cardiovascular risk with higher incidence of myocardial infarction in pts with larger epicardial fat volumes. (