Accumulation of visceral fat may be involved in the upstream of clustering of multiple risk factors. Visceral fat accumulation is influenced by environmental and genetic factors. Visceral fat is a very active tissue in terms of lipogenesis and lipolysis. The FFAs released from visceral adipose tissues such as mesenteric and omentum fat enter the portal vein, leading to enhanced lipoprotein synthesis and hyperlipidemia. TNF-alpha released from visceral fat may cause insulin resistance and impaired glucose metabolism. Adipose tissues secrete a variety of bioactive substances named adipocytokines. PAI-1 synthesized from visceral fat may directly lead to a prothrombotic state. Visceral fat accumulation causes a reduction of serum adiponectin, an adipocyte-derived protein with distinct anti-atherosclerotic effects and can improve insulin resistance. Dysregulation of adipocytokies may lead to insulin resistance and the clustering of multiple risk factors may cause atheroslcerotic CVD.