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Background and Design: Psoriasis is a chronic inflammatory skin condition associated with several systemic comorbidities including cardiovascular diseases (CVD). Epicardial fat pad (EFP) is defined as a visceral fat tissue surrounding the heart and coronary vessels. Recent studies revealed epicardial fat thickness, which is also increased in psoriasis, as an early sign of CVD. The aim of this study was to evaluate EFP prevalence and its associations in psoriasis patients. Materials and Methods: Two hundred thirty-seven psoriasis and 113 control patients were assessed for CVD risk factors, Psoriasis Area Severity Index, body composition parameters and laboratory work-up. Controls were chosen from outpatients who lack any chronic inflammatory skin disease and/or systemic inflammatory disease. Evaluation of chest X-rays were performed by a radiologist who was unaware of clinical data. Results: 42.2% of psoriasis patients (n=100) and 31% of controls (n=35) had EFP detected on chest X-ray revealing psoriasis patients had significantly more prevalent EFP than the controls (p=0.047). Prevalence of major CVD risk factors was statistically higher in psoriasis patients (60%, n=142) compared to controls (32%, n=36), (p<0.01). Psoriasis patients with EFP presented higher prevalence of CVD risk factors (70%, 4, n=69) compared to patients who did not have EFP (53%, n=67) (p=0.009). Conclusion: EFP is associated with concurrent CVD risk factors and is more prevalent in psoriasis. It can be detected by a first-line imaging method like chest X-ray which is quite cheap, easy to perform and applicable to almost each patient.