Epicardial adipose tissue (EAT) is a unique fat depot which has multifaceted effect on local and systemic. EAT has a special anatomical location. The metabolic and histological features are distinguished from other fat depots. Under normal physiological conditions, EAT has thermogenic and mechanical characteristics, which is beneficial for the heart. Under pathological conditions, however, EAT secrete a variety of proinflammatory cytokinesis and adipokines involved in the pathological process of cardiovascular diseases. Thickness/volume and chronic inflammation of EAT was significantly positively correlated with the severity of cardiovascular disease. Exercise, weight loss and some drugs can restore the protective functions of EAT for cardiovascular system, suggesting that EAT maybe serve as a novel indicator for diagnosis, treatment and prognostic evaluation of cardiovascular disease. In this review, we summary the anatomy, function and regulation of EAT, and then discuss the potential roles of the EAT in cardiovascular diseases including vascular remodeling after injury, atherosclerosis, hypertension, arrhythmias and heart failure, which may provide new targets for the prevention and treatment of cardiovascular diseases.