Perivascular adipose tissue (PVAT) had long been considered to serve only structural, vessel-supporting purposes, but today PVAT is recognized to be an endocrine organ with important physiological and pathological effects. The expansion of PVAT in vascular homeostasis and vascular disease has attracted much interest. PVAT has been shown to release a wide spectrum of molecules, such as PVAT-derived relaxing factors (PVATRFs) and PVAT-derived contracting factors (PVATCFs). PVAT dysfunction may lead to obesity, atherosclerosis, and other cardiovascular diseases. This review describes recent advances in our understanding of PVAT's important effects on the cardiovascular system.