Background Epicardial adipose tissue (EAT) is a complex endocrine organ that express a varietyof inflammatory mediators which may contribute to the pathogenesis of coronaryartery disease (CAD). Resistin is a novel adipokine that has been linked toinflammation and atherosclerosis. No data exist regarding the relation between serumresistin, EAT volume, and CAD.Purpose To investigate the relation between serum resistin, EAT volume and coronaryatherosclerotic burden.Methods The study recruited 32 male patients with stable angina pectoris and angiographicevidence of significant (≥ 50%) coronary stenosis (median age: 54 y, body massindex "BMI" 28 kg/m2, 14 diabetes, 20 hypertension, 19 smoking). Eleven agematchedhealthy male volunteers served as control group. All patients were not onstatins. EAT volume indexed to body surface area (EAT-i volume) was quantified bycardiac magnetic resonance (CMR). Coronary artery calcium (CAC) score and plaquevolume were measured by multidetector computed tomography. Serum levels oflipoproteins, adiponectin, leptin, and resistin were measured.Results Both groups were similar in terms of BMI, waist hip ratio, and serum lipoproteinslevels. EAT-I volume (57.1 vs. 24.5 cm3/m2, p<0.001) and serum resistin (7.5 vs. 6.0ng/ml, p=0.017) were significantly higher in CAD patients than control group. EAT-Ivolume showed significant positive linear correlations with serum resistin (r=0.69,p<0.001), CAC score (r=0.51, p=0.003), and coronary plaque volume (r=0.45,p=0.01) in CAD patients. Serum resistin showed significant positive linear correlationwith CAC score (r=0.37, p=0.05). In CAD patients, EAT-I volume was significantlyincreased among resistin tertiles (66.2 vs. 58.2 vs. 38.5, p=0.001). No significantcorrelations were detected between EAT-I volume and serum adiponectin as well asleptin levels. In a multivariate regression analysis, EAT-I volume was the mostpowerful predictor of CAC score compared to other conventional risk factors forCAD [exp(B)=12.0, 95% CI=4.9 – 19.1, p=0.002]. Serum resistin was independentpredictor of increased EAT-I volume [exp(B)= 3.16, 95% CI=1.35 – 4.98, p=0.001].Conclusions Epicardial adipose tissue volume is independently associated with coronaryatherosclerotic burden in stable coronary artery disease patients. Resistin may providea possible mechanistic link between epicardial adipose tissue and coronary atherosclerosis