Objectives: Fat surrounding coronary arteries can aggravate coronary artery disease (CAD). To provide evidence for this concept, we sought to investigate the correlation between epicardial adipose tissue (EAT) volumes and risk factors, plasma visfatin levels, inflammatory biomarkers, and the quantity of coronary calcification and atherosclerosis.Methods: EAT volume was measured using cardiac multi-slice computed tomography. Coronary artery calcium (CAC) was determined by the Agatston Score, and plasma visfatin levels were measured by a competitive enzyme immunoassay.Results: Patients with CAC and coronary atherosclerosis had significantly larger EAT volumes than patients without CAC and coronary atherosclerosis. When the analysis was stratified according to diabetes status, the EAT volumes in CAC and coronary atherosclerosis patients, with or without type 2 diabetes, were significantly higher than those of their counterparts. Furthermore, the correlation of EAT volume and CAC remained statistically significant even after it was adjusted lo r body mass index (BMI). EAT volume was also associated with the Agatston calcium score, volume calcium score, Gensini score, and the Framingham Risk Score. An EAT volume > 200 em^3 was the strongest independent risk factor for CAC. An elevated EAT volume was also significantly correlated with elevated visfatin, triglycerides, high sensitivity C-reactive protein levels, total white blood cells, lymphocyte counts, and low high-density lipoprotein levels.Conclusion: Increased EAT volumes were associated with coronary atherosclerosis and CAC, independent of risk factors, and were correlated with several CAD inflammatory biomarkers. These data suggest that EAT may act through inflammatory react ions to play an important role in the pathogenesis of coronary atherosclerosis and CAC.