This review highlights the role of adipose tissue in the development of systemic inflammation, which contributes to obesity-associated vasculopathy and cardiovascular risk. Adipocytes and adipose tissue-derived macrophages secrete inflammatory mediators that participate in vascular insult and atheromatous change. Key inflammatory proteins, such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), are increased in obesity and are linked to increased cardiovascular risk. The review discusses the mechanisms by which these inflammatory factors contribute to cardiovascular pathology, including their effects on endothelial function, smooth muscle cells, and platelets. It also explores the cardioprotective effects of anti-inflammatory therapies, such as peroxisome proliferator-activated receptor-γ (PPARγ) agonists and angiotensin receptor blockers, which improve adipose tissue physiology and insulin sensitivity while reducing systemic inflammation. The review concludes by emphasizing the importance of targeting anti-inflammatory processes specifically in adipose tissue to prevent cardiovascular disease.This review highlights the role of adipose tissue in the development of systemic inflammation, which contributes to obesity-associated vasculopathy and cardiovascular risk. Adipocytes and adipose tissue-derived macrophages secrete inflammatory mediators that participate in vascular insult and atheromatous change. Key inflammatory proteins, such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), are increased in obesity and are linked to increased cardiovascular risk. The review discusses the mechanisms by which these inflammatory factors contribute to cardiovascular pathology, including their effects on endothelial function, smooth muscle cells, and platelets. It also explores the cardioprotective effects of anti-inflammatory therapies, such as peroxisome proliferator-activated receptor-γ (PPARγ) agonists and angiotensin receptor blockers, which improve adipose tissue physiology and insulin sensitivity while reducing systemic inflammation. The review concludes by emphasizing the importance of targeting anti-inflammatory processes specifically in adipose tissue to prevent cardiovascular disease.