Aim To explore the correlation between ultrasound evaluation of epicardial adipose thickness (EAT) and right common carotid artery elasticity and carotid intima-media thickness (CIMT) in middle-aged and elderly coronary heart disease (CHD) patients. Methods The middle-aged and elderly patients (100 cases) who visited Nanyang Central Hospital from February 2018 to June 2021 and were diagnosed with CHD by coronary angiography(CAG) were selected as the research subjects. According to the number of diseased branches, they were divided into single (31 cases), double (36 cases) and triple (33 cases) vessel lesions groups. In addition, physical examination population without coronary heart disease (50 cases) at Nanyang Central Hospital during the same period were selected as the control group. The general information and ultrasonic testing parameters of the four groups of subjects were compared and analyzed. Pearson was used to analyze the correlation between EAT and the elasticity of the right common carotid artery, CIMT. The receiver operating characteristic (ROC) curve was used to analyze the value of EAT, right common carotid artery elasticity and CIMT in predicting CHD. Results Compared with the control group, vascular stiffness (β), elastic modulus (Ep), pulse wave velocity (PWV-β), CIMT, and EAT were increased in the single vessel lesion group, double vessel lesions group, and triple vessel lesions group (all P＜0.05), aortic compliance (AC) were decreased (all P＜0.05). Pearson analysis showed that EAT was positively correlated with β, Ep, PWV-β and CIMT (P＜0.05), and negatively correlated with AC (P＜0.05). The results of ROC curve analysis showed that the sensitivity, specificity and Youden index of the three combined detection (EAT, CIMT and right common carotid artery elasticity) were 89%, 82% and 71%in predicting the occurrence of CHD, respectively. Conclusion EAT in middle-aged and elderly patients with CHD has a good correlation with the elastic changes of the right common carotid artery, CIMT. The combined detection of EAT, right common carotid artery elasticity changes, and CIMT can provide a good basis for clinical prediction of CHD.