Article Text

Download PDFPDF

Adiposity measures and arterial stiffness in primary care: the MARK prospective observational study
  1. Leticia Gomez-Sanchez1,2,
  2. Luis Garcia-Ortiz1,2,3,
  3. Maria C Patino-Alonso1,2,4,
  4. Jose I Recio-Rodriguez1,2,5,
  5. Fernando Rigo6,
  6. Ruth Martí7,8,
  7. Cristina Agudo-Conde1,2,
  8. Emiliano Rodriguez-Sanchez1,2,9,
  9. Jose A Maderuelo-Fernandez1,2,
  10. Rafel Ramos7,8,10,
  11. Manuel A Gomez-Marcos1,2,9
  12. for the MARK Group
  1. 1 Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service (SACyL), Salamanca, Spain
  2. 2 Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
  3. 3 Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
  4. 4 Department of Statistics, University of Salamanca, Salamanca, Spain
  5. 5 Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
  6. 6 San Agustín Health Center, Illes Balears Health Service (IBSALUT), Palma of Mallorca, Spain
  7. 7 Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain
  8. 8 Institut d’Investigació Biomèdica of Girona Dr. Josep Trueta (IDBGI), Girona, Spain
  9. 9 Department of Medicine, University of Salamanca, Salamanca, Spain
  10. 10 Departament of Ciències Mèdiques, Universitat de Girona, Girona, Spain
  1. Correspondence to Leticia Gomez-Sanchez; Leticiagmzsnchz{at}


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.

  • body mass index
  • waist circumference
  • waist-to-height ratio
  • fat mass percent
  • body roundness index
  • arterial stiffness

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from


  • Contributors LG-S designed the study, wrote the protocol, participated in fundraising, interpreted the results, prepared the manuscript draft, performed all analytical testing, interpreted the results and reviewed the manuscript and corrected the final version of the manuscript. JIR-R, RM, FR and CA-C participated in the study design, data collection and manuscript review. ER-S and JAM-F participated in the study design, interpretation of results and manuscript review. MCP-A participated in the analysis of results and final review of the manuscript. LG-O, RR and MAG-M participated in the protocol design, fundraising, analysis of results and final review of the manuscript. All authors reviewed and approved the final version of the manuscript.

  • Funding This research was supported by grants from the Spanish Ministry of Science and Innovation (MICINN), the Carlos III Health Institute/European Regional Development Fund (ERDF) (MICINN, ISCIII/FEDER) (Red RedIAPP RD06/0018), Research Groups: (RD16/0007/0003 (PI10/01088, PI10/02077, PI10/02043, PI13/01930) and the Regional Health Management of Castile and León (GRS 635/A/11; GRS 906/B/14).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Clinical Research Ethics Committee of the Primary Care Research Institute Jordi Gol, the Health Care Area of Salamanca and Palma of Mallorca.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used for the analysis of the results of this study are available and will be facilitated by the author.

  • Collaborators MARK Group. redIAPP: Research Network in Preventive Activities and Health Promotion, Girona, Spain.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.