Accumulating evidence revealed that adipose tissues secrete pro-inflammatory and anti-inflammatory humoral factors, called as adipocytokines. Most of the arteries are surrounded by perivascular adipose tissue (PVAT), which influences adjacent artery by secreting adipocytokines. PVATs are supposed to be athero-protective under healthy conditions, whereas PVATs are athero-promoting in obesity. Recent clinical studies suggested that coronary atherosclerosis is associated with increased volume of epicardial adipose tissue (EAT), PVAT of coronary artery. It was suggested that enhanced inflammation in EAT is also associated with vasospastic angina. In this review article, we will summarize recent findings about potential roles of EAT in the pathogenesis of coronary atherosclerosis.