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Obesity is associated with significant cardiovascular morbidity and mortality. Epicardial fat is an active organ and source of several bioactive molecules that can affect cardiac morphology and function. A relationship between epicardial fat thickness, inflammation and cardiovascular disease has been reported although this relationship is still under question. This review will explore the current understanding of ectopic cardiac adipose tissue storage, and existing research supporting an association between ectopic cardiac fat, inflammation and cardiovascular disease.