As an important risk factor for the development of atherosclerosis, the occurrence of obesity is accompanied by changes in cholesterol content and distribution in adipocytes. Cholesterol is an essential component and regulator of lipid rafts in cell membrane. Moreover, it itself is a signaling molecule, which can directly regulate the metabolism and function of adipocytes. The ability of adipocytes to synthesize cholesterol is very limited, so they rely mainly on uptake and flow to regulate cholesterol homeostasis. Recent studies have found that blocking the active efflux of cholesterol on fat cells can inhibit the occurrence of obesity. This article will detailedly describe the cholesterol uptake and efflux pathways of adipocytes, and elucidate the importance of cholesterol homeostasis for adipocytes and the role of adipocyte cholesterol homeostasis in the development of atherosclerosis.