Introduction: Visceral obesity is associated with an adverse metabolic and cardiovascular risk profile.1 Myocardial fat deposited around the heart can be subdivided into epicardial adipose tissue (EAT), enclosed by the visceral pericardial sac, and pericardial layer, anterior to EAT. It has been postulated that the outer pericardial layer remains relatively inert however EAT hosts a metabolic active role 2 MRI has become gold standard for assessing the structure and function of the heart, but quantitative assessment of myocardial fat using MRI may provide additional prognostic information. The purpose of this study was to measure the extent of EAT in a diabetic population (DM) with cardiovascular disease (CV) using MRI, and to correlate these measures with MRI-derived pulse wave velocity (PWV) as an index of arterial stiffness. Methods: Fifty fully consenting patients were recruited into the following cohorts: (G1) Type 2 DM with CVD, (G2) Type 2 DM without CVD, (G3) no DM with CVD, and (G4) no DM and no CVD. Each patient underwent a cardiovascular MR imaging assessment on a 3T Magnetom Trio MRI scanner (Erlangen, Germany). For derivation of the EAT region, a cardiac-gated 2D CINE segmented TrueFISP sequence was acquired in the four-chamber orientation. Segmentation of the region was manually contoured at end-diastole (ED) and subsequently reviewed by an experienced radiologist. The PWV was acquired from axial oblique cardiac-gated 2D segmented free-breathing CINE phase-contrast MRA (PC-MRA) sequences at slice locations across the aortic arch and the descending aorta above the renal bifurcation. Image processing was performed using Segment v1.9 R1917 (Heiberg, Germany). The PWV was calculated using the transit time method, and the distance between each measurement plane. Results are expressed as mean+/- SD. Comparison of variables was performed by means of a two-tailed t-test. Results: For EAT, G1 (5.32+/-1.9cm^2), G2 (4.52+/-2.07cm^2) and G3 (4.98+/-1.80cm^2) were found to be highly significant in comparison to G4 (P<0.001) however no significance was between patient groups. PWV values in G1 (DM and CVD) 8.42+/-2.55 m/s and G3 (CVD) 8.98 +/-3.14 m/s compared to control cohort G4: 6.50+/-1.74 m/s was found to be significant (p=0.03, p=0.02). No significance was found with G2 (DM only) and G4 or between the patient groups (G1,2,3). Conclusion: Recent studies are beginning to highlight EAT playing an active role as a cardiometabolic risk factor.3 In this study, EAT was found to be associated with CVD and DM. However arterial stiffness, a known marker of CVD and DM,4 showed an association with CVD and DM but not solely DM.