Systemic sclerosis is associated with an increased prevalence/incidence of coronary artery disease. The aim of this study was to investigate epicardial adipose tissue (EAT) thickness which may contribute to cardio-metabolic risk in systemic sclerosis (SSc) patients without overt cardiac disease. EAT thickness was measured by transthoracic conventional Doppler echocardiography and compared in SSc patients (n=47) and age- and sex-matched healthy controls (n=36). The relationships between EAT thickness and markers of cardio-metabolic risk in SSc were examined. EAT thickness was significantly greater in patients with SSc compared to healthy controls (6 [7-5] vs 5 [6.75-3.25], p=0.041). Compared to controls, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leukocyte, neutrophil, B-type natriuretic protein (BNP), fasting plasma insulin and HOMA-IR were elevated (18 [31-10] vs 8.5 [18-4], p<0.001; 0.4 [0.67-0.18] vs 0.21 [0.48-0.09], p=0.012; 7510 [8731-5990] vs 6435 [7360-5195], p=0.002; 4350 [5440-3570] vs 3390 [4168-2903], p<0.001; 111 [185-74] vs 70 [127-70], p=0.010; 6.7 [10.5-4.7] vs 4.7 [6.8-4.1], p=0.008; 1.7 [2.6-1] vs 1.1 [1.7-0.9], p=0.015, respectively). The total and low-density lipoprotein (LDL)-cholesterol were decreased in SSc patients (197 +/- 45 vs 284 +/- 36, p=0.005; 118 [148-84] vs 140 [180-115], p=0.003, respectively). In patients with SSc, the EAT thickness correlated positively with age, ESR, CRP, insulin, hemoglobin A1c and total and LDL-cholesterol (r=0.574, p<0.001; r=0.352, p=0.015; r=0.334, p=0.022; r=0.290, p=0.048; r=0.317, p=0.030; r=0.396, p=0.006 and r=0.349, p=0.016, respectively). Our study confirms that EAT thickness is greater in SSc patients compared to healthy controls using echocardiographic measurements. The results of our study suggest that EAT thickness is a candidate for atherosclerotic risk assessment in SSc.