Aging is characterized by several changes in body mass composition with loss of muscle mass and increase in fat mass, particularly visceral fat. Visceral fat is represented mainly by abdominal and cardiac depots and it is directly related to chronic low-grade inflammation, insulin-resistance and metabolic syndrome. Unfavourable outcomes as cardiovascular death are also associated with the amount of visceral fat depots. In this scenario, the cardiac visceral fat seems to play an important role in increasing the cardiometabolic risk. This review aims to provide a literature revision about the role of cardiac visceral fat on cardiometabolic risk in elderly.