Abstract Background Epicardial adipose tissue is correlated to the amount of visceral fat and is a marker of metabolic and cardiovascular risk. Aging alters body fat mass and its function. Epicardial fat (EF) thickness, as measured by ultrasonography, reflects intra-abdominal visceral fat and is related to features of the metabolic syndrome and to cardiovascular risk. The aim of our study was to evaluate differences in the EF thickness between young-middle aged and old aged subjects. Methods We evaluated EF thickness in 26 young-middle aged subjects (age ± SD 45.9 ± 10.3 years) compared to 50 old aged subjects (age ± SD 76.1 ± 7.3 years) with the common cardiovascular risk factors. Each subject underwent transthoracic M-mode echocardiogram to measure EF thickness. Results Old aged subjects had thicker EF (11.3 ± 1.9 mm versus 9.3 ± 2.8 mm, p Conclusion epicardial adipose tissue is more abundant in the elderly and is correlated to visceral adipose tissue depots, indicating a higher cardiometabolic risk especially in male subjects.