Obesity is a chronic metabolic disease caused by a variety of factors, manifested by excessive accumulation of body fat and/or abnormal fat distribution. The main pathogenesis of atherosclerosis is lipid accumulation within the artery walls, the proliferation of smooth muscle cell and fibrous matrix, and development of atherosclerosis plaques. A large number of basic and clinical studies have shown that obesity is a well-established risk factor for atherosclerosis, and its potential mechanisms include abnormal lipid metabolism, insulin resistance, inflammation, and endothelial dysfunction.However, the mechanistic link between accumulation of adipose tissue and development of atherosclerosis is not clear. This article will focus on the opinions of epicardial adipose tissue and perivascular adipose tissue, new adipokines, adipose-derived exosomes, and adipose browning, in order to state the impact of obesity on atherosclerosis and to provide a new perspective for the study of intervention strategies for atherosclerosis.