: In adults, epicardial adipose tissue (EAT) is associated with metabolic syndrome (MS) and coronary artery disease. EAT thickness is increased in obese youth, but total EAT volume and its correlation with cardiovascular risk factors have not been studied. : To determine EAT volume in adolescents and its association with obesity and cardiovascular risk factors. We performed a cross-sectional study including 48 pubertal adolescents (24 obese and 24 lean subjects, aged 13.6 ± 1.5 yr). EAT volume as well as visceral and subcutaneous abdominal adipose tissue volumes were obtained by magnetic resonance imaging. Anthropometrical parameters; blood pressure (BP); fasting serum triglycerides; total and low- and high-density lipoprotein (HDL-C) cholesterol; glucose; and insulin levels were measured. : Obese adolescents had higher EAT volume compared to lean controls (49.6 ± 18.0 vs. 17.6 ± 6.7 cm, < 0.0005). They also had significantly increased visceral abdominal fat volumes, systolic BP, serum triglycerides, and insulin levels, and decreased HDL-C concentration. EAT volume was significantly associated with anthropometrical indices and cardiovascular risk factors: waist circumference, systolic BP, triglycerides, HDL-C levels, and insulin resistance indices. Metabolic syndrome was present in 25% of obese adolescents. EAT volume was significantly higher in obese adolescents with MS compared to those without MS (63.5 ± 21.4 vs. 44.9 ± 14.6 cm, = 0.026). : EAT volume, which is known to contribute to atherogenesis in adults, is increased in obese adolescents, and is associated with abdominal visceral fat, cardiovascular risk factors, and MS. Excessive EAT early in life may contribute to the development of premature cardiometabolic disease.