ABSTRACT The interplay between perivascular adipose tissue (PVAT), “the obesity triad” (hypoxia, inflammation, oxidative stress), and the resulting atherosclerosis is gaining a large body of knowledge, but many questions remain to be answered. The state of the adipose tissue surrounding vessels has a significant role in the health of the vascular tissue and cardiovascular function. PVAT is not simply a structure that holds vasculature in place, but rather an active endocrine tissue with many functions including a role in vascular tone and atherogenesis. Recently, there has been growing consensus with evidence to support that high cholesterol levels are not necessarily where the focus should be when addressing atherosclerosis and cardiovascular disease. Recent evidence suggests that an increase in the quantity of adipose tissue (vis-a-vis obesity) negatively affects the composition of PVAT and leads to increases in oxidative stress, decreased blood flow, and increases in immunological activity, increasing inflammatory mediators. These inflammatory mediators are likely more important in forming atherosclerotic plaques than cholesterol. More data-gathering is indicated to find more of those molecules and to understand more deeply how obesity degrades PVAT.Keywords: Perivascular adipose tissue, white adipose tissue, brown adipose tissue,atherosclerosis, PCSK-9, atherogenesis, obesity, monoclonal antibody, inflammation
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