Adiposity measures and arterial stiffness in primary care: the MARK prospective observational study

BMJ Open. 2017 Sep 27;7(9):e016422. doi: 10.1136/bmjopen-2017-016422.


Background: The cardiovascular risk of obesity is potentially increased by arterial stiffness.

Objective: To assess the relationship of adiposity measures with arterial stiffness in Caucasian adults with intermediate cardiovascular risk.

Setting: Six Spanish health centres.

Participants: We enrolled 2354 adults (age range, 35-74 years; mean age, 61.4±7.7 years, 61.9% male).

Methods: This is a cross-sectional study that analyses data from the baseline visit of the improving interMediAte RisK management (MARK) study. The main outcome variables were body mass index (BMI), waist-to-height ratio (WHtR), Clínica Universidad de Navarra-body adiposity estimation (CUN-BAE) body fat percentage and body roundness index (BRI). Vascular function was assessed by the cardio-ankle vascular index (CAVI) with the VaSera device; brachial-ankle pulse wave velocity (baPWV) was determined using a validated equation.

Results: The mean adiposity measures were a BMI of 29.2±4.4, WHtR of 0.61±0.07, CUN-BAE of 35.7±1.7 and BRI of 5.8±1.7. The mean stiffness measures were a CAVI of 8.8±1.2 and baPWV of 14.9±2.5. In multiple linear regression analyses, all adiposity measures were negatively associated with CAVI and baPWV (p<0.01 for all) after adjustment for possible factors of confusion. The proportion of CAVI variability via the adiposity measures were 5.5% for BMI, 5.8% for CUN-BAE, 3.8% for WHtR and 3.7% for BRI. These were higher among diabetic, obese, younger (≤62 years) and non-hypertensive subjects who had similar activity and sedentary profiles.

Conclusions: Adiposity measures are negatively associated with arterial stiffness measures. The percentage of variation in CAVI explained by its relation to the different measures of adiposity ranges from 5.8% (CUN-BAE) to 3.7% (BRI). In the case of baPWV, it oscillates between 0.7% (CUN-BAE and BMI) and 0.1% (WHtR).

Trial registration number: NCT01428934.

Keywords: arterial stiffness; body mass index; body roundness index; fat mass percent; waist circumference; waist-to-height ratio.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adiposity*
  • Adult
  • Aged
  • Ankle Brachial Index
  • Blood Pressure
  • Body Mass Index
  • Cardiovascular Diseases / physiopathology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / physiopathology*
  • Primary Health Care
  • Prospective Studies
  • Pulse Wave Analysis
  • Risk Assessment
  • Spain
  • Vascular Stiffness*
  • Waist Circumference
  • Waist-Height Ratio

Associated data