Adipose tissue exhibits a high level of metabolic activity that stems from the synthesis and secretion of hormones associated with energy metabolism. These hormones have a direct effect on the structure and function of the heart and on the cardiovascular system as a whole. Since the discovery of leptin, a group of adipokines produced mainly by adipose tissue, but also by other tissues, has been identified. Interestingly, these adipokines may also be synthesized and secreted by cardiomyocytes, and they have a direct influence on cardiomyocyte structure and metabolism. Epicardial fat is an important part of visceral fat and has a high level of metabolic activity. Compared with subcutaneous fat, this fat compartment expresses less adiponectin but more interleukins, and it is linked to the severity of coronary artery disease and the presence of hypertension. The adipokines form a family of hormones whose actions exert significant effects on the cardiovascular system. In particular, they are associated with atherothrombosis and could provide a new therapeutic target for reducing cardiovascular risk.