The prevalence of obesity has increased dramatically in recent years. The association between abdominal fat distribution and cardiometabolic syndrome has been proved in many studies. Cardiometabolic syndrome is associated with a number of cardiovascular risk factors that contribute to a high rate of vascular events, which are now the most common cause of death. Operational definitions of metabolic syndrome have been changed several times, with a tendency to emphasize the importance of central adiposity. Adipose tissue is now known to secrete a number of pro-inflammatory agents that are thought to mediate the link between obesity, insulin resistance, hyperlipidaemia, and atherosclerosis. The aim of this article is to correlate data in this area, highlighting the central role of excess visceral fat and its secreted adipokines, and to review existing therapies.