Key Concepts:- While traditionally viewed as little more than a simple lipid reserve, perivascular adipose tissue (PVAT) boasts an extensive biological arsenal which when mobilized can modulate vascular function.- PVAT dysfunction in disease is associated with alteration to its secretory profile which can create a contractile and pro-inflammatory effect.- PVAT dysfunction may be responsible for the comorbidity and mortality seen in various disease states, particularly the development of hypertension inobesity – now one of the world’s leading causes of mortality.- Recently, it has been discovered that PVAT has a role as a sensor of coronary inflammation. This can be detectedusing a novel CT-derived metric, representing the first attempt at clinical translation of PVAT biology.