The association between pericardial fat, intrathoracic fat and intra-abdominal (visceral) adipose tissue and the prevalence of cardiovascular disease was evaluated in participants of the Framingham Heart Study Offspring cohort (n=1,267). Pericardial fat and intra-abdominal adipose tissue but not intrathoracic fat were significantly associated with prevalent cardiovascular disease after adjusting for age, sex, body mass index and waist circumference. However, these associations were no longer significant after further adjustments for traditional risk factors. Finally, only pericardial fat was associated with prevalent myocardial infarction after adjusting for conventional measures of adiposity.