Obesity is associated with increased risk of cardiovascular morbidity. Biologically active molecules produced by adipose tissue constitute a critical link between obesity and cardiovascular complications. Adipose tissue has recently been recognized to be an important endocrine organ that controls energy metabolism. It also secretes adipocytokines, which can modify vascular responses, and antifibrinolytics, including plasminogen activator inhibitor 1, which favors fibrin accumulation, and proinflammatory cytokines, which facilitate the inflammatory response. Here we review new advances in our understanding of the mechanisms linking the endocrine activity of adipose tissue to vascular risk.