Aim: To study effect of epicardial adiposity on risk of development and severity of coronary atherosclerosis., Material and Methods: We registered classical metabolic risk factors (RF) and additional factors of cardiovascular risk in 138 men aged 55.47+/-9.07 years with ischemic heart disease (IHD), functional class (FC) II-III angina, and I-III degree obesity. Diagnostic coronary angiography (CAG) was performed in all patients. Thickness of epicardial fat (tEF) in millimeters was measured at transthoracic echocardiography (ECG)., Results: Average tEF indexes were highest (10 [8; 10] mm) in the group of patients with multiple stenoses in coronary arteries (CA). According to ROC-analysis tEF appeared to be a predictor of significant coronary atherosclerosis. Its sensitivity was 80.4%, specificity - 67.6 % (cut-off value 6 mm). Epicardial adiposity was among factors associated with presence of coronary atherosclerosis (odds ratio [OR] 4.44, 95% confidence interval [CI] 2,06 to 9.59; p<0,001) along with age (OR 6.56; 95% CI 2.59 to 16.60; p=0,001), leptin (OR 3.50; 95% CI 1.46 to 8.37; p <0,001), resistin (OR 3.13; 95% CI 1.32 to 7.42; p <0,001) and waist circumference (OR 1.65; 95% CI 0.72 to 3.80; p=0.018).