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Purpose Major burden of cardiovascular disease (CVD) mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and non-invasive methods is valuable. Epicardial adipose tissue thickness (EAT) through transthoracic two dimensional (2D) echocardiography determines highly active intrathoracic visceral adipose tissue burden which increases atherosclerosis. 1 We did this study to find the utility of EAT in predicting coronary artery disease (CAD) burden and compare with carotid intima media thickness (CIMT) which is an established surrogate marker of atherosclerosis. Methods In this cross-sectional comparative study, we measured EAT by 2D echocardiography and CIMT by B-mode ultrasound in 161 patients, who underwent coronary angiogram (CAG) for various clinical indications. Coronary artery disease was considered significant if more than 70% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise. Results On coronary aniography (CAG) 65.2% of patients had significant CAD, 24.3% had insignificant disease and 10.5% had normal coronaries. Epicardial adipose tissue was 0.59 ± 0.26 cm in normal coronary artery group, 0.61 ± 0.20 cm in insignificant CAD group and 0.72 ± 0.19 cm in significant CAD group (p Conclusions EAT and CIMT can predict CAD burden in a robust way. EAT may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide to implement preventive therapy for cardiovascular disease.