The regulatory role of pericoronary adipose tissue (PCAT) in cardiovascular diseases is of paramount importance. PCAT exerts extensive pathophysiological effects on the cardiovascular system by secreting various bioactive substances, such as adipokines and cytokines. Currently, the attenuation value of PCAT can be detected via coronary computed tomography angiography (CCTA), a method that not only reflects the level of vascular inflammation but also holds significant clinical value in the detection and prognostic assessment of coronary heart disease plaques. Therefore, this article reviews the pathophysiological mechanisms of PCAT and its clinical significance in coronary heart disease.