0021-9150/$ e see front matter 2013 Elsevier Irela http://dx.doi.org/10.1016/j.atherosclerosis.2013.02.030 In this issue of the journal Choi et al. [1] describe a close association of epicardial and pericardial adipose tissue (EAT and PAT) andmarkers of cardiovascular disease such as increased pulsewave velocity (PWV, an index of increase vascular stiffness) and coronary artery calcium (CAC, a visual marker for the presence of subclinical atherosclerosis). The attention of cardiovascular epidemiologists has turned in recent years to regional deposits of adipose tissue such as intra-abdominal visceral adipose tissue (VAT) and EAT. The hidden dangers behind a large amount of intra-abdominal fat were first hailed by Dr. Vague in a 1956 publication [2] where he stressed that the male-type (central) obesity phenotype was a precursor of diabetes, gout and atherosclerosis. Several years later numerous publications pointed at the importance of simple measures of obesity such as body mass index (BMI) and waist-to-hip ratio (WHR) as markers of risk [3]. With the introduction of medical imaging, it became apparent that a large waistline does not necessarily indicate the presence of a large VAT deposit, as it can also mean that the subcutaneous fat pad is increased or that both subcutaneous and visceral adipose tissues are simultaneously increased. In time, it became clear that a substantial increase in subcutaneous fat in the absence of a large deposit of VAT is likely benign in terms of cardiovascular risk, while increased VAT was associated with insulin resistance, dyslipidemia, inflammation and