**Abstract**

Obesity is considered a pandemic of the present century and is associated with severe noncommunicable chronic diseases, especially cardiovascular diseases, which remain the leading cause of death in the world. Visceral adiposity is a usual localization for ectopic fat depots and increases the risk of cardiovascular diseases. Endothelial dysfunction in obesity explains atherosclerosis and higher risk of incident coronary artery disease. Further microvascular disease caused by chronic inflammatory state increases cytokines and reduces the nitric oxide, and chronic inflammation has been characterized by the imbalance between proinflammatory and procoagulant and antiinflammatory and anticoagulant activities of the endothelium to generate a procoagulant state. An important topic is the gut microbiota that influences the progression of atherosclerosis. Some studies have shown the influence of gut dysbiosis and progression of atherosclerosis and cardiovascular disease. Additionally studies talking about overweight and obesity with coronary artery disease are explained by levels of blood pressure, cholesterol, and glucose; however, another important causative factor is the ectopic fat deposition, especially pericardial and epicardial spaces, which may further contribute to the burden of coronary atherosclerosis. So, diagnosis of cardiovascular diseases in obesity requires a lot of knowledge to suspect, diagnose, and to treat.

**Keywords:** obesity, cardiovascular risk, fatty tissue, atherosclerosis, coronary artery disease (CAD)
