Obesity and cardiovascular diseases have become one of the most pressing public health challenges of the 21st century, garnering widespread attention worldwide. Adipose depot expansion can occur through either an increase in the size of adipocytes (hypertrophy) or the generation of new adipocytes via precursor differentiation during adipogenesis (hyperplasia). Hypertrophy of adipocytes in obesity causes increased hypoxia, triggering fibrosis, inflammation, and necrosis, which contribute to systemic complications, including coronary artery disease, heart failure, and stroke. Furthermore, enlarged adipocytes release pro-inflammatory cytokines like TNF-α and IL-6, driving chronic inflammation that contributes to atherosclerosis, increasing the risk of heart attacks and strokes. We aim to discuss recent insights into the mechanisms by which obesity leads to cardiovascular diseases, which will provide new perspectives for the treatment of obesity and cardiovascular diseases.