Perivascular adipose tissue (PVAT) is an important regulator of endovascular homeostasis. It is a special adipose tissue around blood vessels. In addition to supporting tissue, it is also an endocrine organ, which can lead to vascular dysfunction in the process of aging. PVAT can release a variety of adipose cytokines, chemokines and growth factors. PVAT-derived factors regulate vascular signaling and inflammation to regulate the function of adjacent layers of the vascular system in an endocrine and paracrine manner. Under physiological conditions, PVAT can store and burn lipids, generate heat, and absorb fatty acids from the blood. PVAT can also release a variety of vasoactive molecules, such as NO, H₂S and adiponectin, to prevent the development of atherosclerosis. At the same time, PVAT plays a key role in the development of atherosclerosis. When obesity, type 2 diabetes mellitus, vascular injury and aging can lead to PVAT dysfunction, vascular endothelial cell and smooth muscle cell dysfunction. The main manifestation is the release of pro-inflammatory adipokines by PVAT, which further causes endothelial dysfunction, inflammatory cell infiltration and vascular smooth muscle cell migration, thus promoting the development of atherosclerosis. PVAT is considered to be a predictor of age-related vascular diseases and a potential target for therapeutic intervention. In this review, we summarize the relationship fo PVAT with age-related vascular diseases, and the role of PVAT in different diseases related to vascular system was reviewed.