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Arquivos Brasileiros de Cardiologia

Print version ISSN 0066-782X

Arq. Bras. Cardiol. vol.100 no.1 São Paulo Jan. 2013  Epub Dec 11, 2012 

Pulse wave velocity, blood pressure and adipocytokines in young adults: the Rio de Janeiro study



Oswaldo Luiz Pizzi; Andréa Araujo Brandão; Roberto Pozzan; Maria Eliane Campos Magalhães; Erika Maria Gonçalves Campana; Flavia Lopes Fonseca; Elizabete Viana de Freitas; Ayrton Pires Brandão

Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

Mailing Address




BACKGROUND: Data on noninvasive vascular assessment and their association with cardiovascular risk variables are scarce in young individuals.
OBJECTIVE: To evaluate the association between pulse wave velocity and blood pressure, anthropometric and metabolic variables, including adipocytokines, in young adults.
METHODS: A total of 96 individuals aged 26 to 35 years (mean 30.09 ± 1.92; 51 males) were assessed in the Rio de Janeiro study. Pulse wave velocity (Complior method), blood pressure, body mass index, glucose, lipid profile, leptin, insulin, adiponectin and insulin resistance index (HOMA-IR) were analyzed. Subjects were stratified into three groups according to the PWV tertile for each gender.
RESULTS: The group with the highest pulse wave velocity (PWV) tertile showed higher mean systolic and diastolic blood pressure, mean blood pressure, body mass index, insulin, and HOMA-IR, as well as lower mean adiponectin; higher prevalence of diabetes mellitus/glucose intolerance and hyperinsulinemia. There was a significant positive correlation of PWV with systolic blood pressure, diastolic blood pressure, pulse pressure and mean blood pressure, body mass index, and LDL-cholesterol, and a negative correlation with HDL-cholesterol and adiponectin. In the multiple regression model, after adjustment of HDL-cholesterol, LDL-cholesterol and adiponectin for gender, age, body mass index and mean blood pressure, only the male gender and mean blood pressure remained significantly correlated with PWV.
CONCLUSION: PWV in young adults showed a significant association with cardiovascular risk variables, especially in the male gender, and mean blood pressure as important determinant variables. The findings suggest that PWV measurement can be useful for the identification of vascular impairment in this age group. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Keywords: Blood Pressure; Risk Factors; Pulse; Vascular Diseases / prevention & control; Adiponectin.




It is currently accepted that atherosclerosis has its origin in childhood1-3. The search for markers of preclinical atherosclerosis/arteriosclerosis is directed to the noninvasive evaluation of the vascular involvement and some studies have demonstrated the association of risk factors (RF) in young individuals with impaired arterial elasticity in adulthood4.

Among the markers of arterial disease, arterial stiffness has shown to be an important parameter for the assessment of cardiovascular risk. Of the several methods for the assessment of arterial stiffness, measurement of the carotid-femoral pulse wave velocity (PWV) is considered the gold standard method because it is relatively easy to perform and there is a large body of evidence demonstrating its association with cardiovascular disease, regardless of traditional risk factors in different populations5,6.

Previous studies on the association between PWV and conventional RF in young individuals are limited and the results are partially controversial4. In the Bogalusa study7, systolic blood pressure (SBP), body mass index (BMI) and HDL-cholesterol (HDL-c) in childhood correlated inversely with PWV in adulthood. In another study8, mean blood pressure (MBP), BMI, gender and homocysteine levels were independently associated with PWV. In the Arya study9, no association was observed between blood pressure (BP) in adolescence and PWV in adulthood.

Therefore, some authors have suggested that in normotensive young adults, PWV is most likely determined by other factors, rather than those found in older individuals with hypertension10. They may be associated with primary abnormalities in the structure or function of the vascular wall4,11.

Studies on this subject have been carried out in young populations, seeking to evaluate RF and early vascular abnormalities. Such information could be useful for better identification and risk stratification in young adults12.

The present study is part of the Rio de Janeiro study (ERJ)13-15, a longitudinal line of research on blood pressure (BP) and other cardiovascular RF in children and adolescents and their families, which has been developed since 1983 and aims to evaluate the association between PWV and BP, anthropometric and metabolic variables, including adipocytokines, in young adults.



We evaluated 96 individuals (51 men), from the ERJ cohort, aged 26 to 35 years (mean 30.09 ± 1.92 years). All of them underwent the evaluation protocol which included measurement of BP, waist circumference (WC), weight, height, and BMI calculation, as well as measurement of blood glucose, total cholesterol, HDL cholesterol and triglycerides (TG) levels after a 12-hour fasting. Leptin, insulin, adiponectin levels were also determined; the insulin resistance index HOMA-IR was calculated and PWV was obtained.

The individuals were stratified by gender according to PWV tertiles in three groups: 1st tertile (Group 1) comprising men with PWV < 8.69 m/s and women with PWV < 7.66 m/s; 2nd tertile (Group 2) consisting of men with PWV > 8.69 m/s and women with PWV > 7.66 m/s; 3rd tertile (Group 3) consisting of men with PWV > 9.65 m/s and women with PWV > 8.31 m/s (Table 1).



WC was obtained according to the procedure described by Callaway et al16 and defined as increased when > 102 cm in men and > 88 cm in women, according to the VI Brazilian Guidelines on Hypertension17.

Blood pressure was measured on the brachial artery using a mercury sphygmomanometer, with a cuff of appropriate size and width, according to the recommendations of the Brazilian Society and Cardiology (SBC)17. Two BP measurements were obtained at a five-minute interval and the final measurement was used for the analysis. Subjects were considered hypertensive when the blood pressure values were > 140 x 90 mmHg, according to the recommendations of the VI Brazilian Guidelines on Hypertension17.

Plasma glucose, total cholesterol, HDL-cholesterol and triglyceride levels were determined using the Konelab kit (BI WINER 3000). Cholesterol levels were determined based on the values established by the IV Brazilian Guidelines on Dyslipidemia and Atherosclerosis Prevention Guidelines of the Department of Atherosclerosis of the Brazilian Society of Cardiology18. Glucose values were interpreted according to the recommendations of the American Diabetes Association19.

Quantitative analysis of serum insulin, leptin and adiponectin levels were performed by fluoroimmunoassay (Luminex xMAP, Luminex Corporation, 12212 Technology Blvd. Austin, TX 78727 U.S.) with the kits CAT#HGT-68K-02 for insulin and leptin and CAT#HCVD1-67AK-03 for adiponectin. For the determination of hyperinsulinemia a cutoff of 20 (µU/mL) was used, as recommended by the manufacturer of the method used.

The insulin resistance index HOMA-IR was calculated according to the equation proposed by Mathews in 1995: HOMA-IR = fasting insulin (µU/mL) x fasting glucose (mmol/L) / 22.520.

Pulse wave velocity (PWV) was measured using the automated computerized system Complior (Complior, Colson, Garger les Genosse, France - Createch Industrie) according to the methodology described by Asmar et al21. The mean of 10 measurements was considered for each individual. All measurements were obtained by the same examiner.

ANOVA was used to compare the means of continuous variables complemented by paired analysis. The Chi-square test was used to compare the frequency distributions of categorical variables for independent samples. Linear regression, complemented by analysis of variance, was used for correlation of continuous variables. The level of significance was set at 5% for all analyses, assuming a probability "p" equal to or less than 0.05 to reject the null hypothesis.

The study protocol was approved by the Institutional Ethics and Research Committee and all subjects gave written consent to participate in the study.



Tables 2 and 3 show the characteristics of the study population stratified by PWV tertiles, regarding pressure, anthropometric and metabolic variables.

The group with the highest PWV tertile had higher SBP, DBP, pulse pressure (PP) and MBP than the group with the lowest PWV tertile (Table 2), although the prevalence of hypertension was similar in the three groups (Table 3).

The group with the highest PWV tertile had higher mean BMI. There was no statistically significant difference between groups for the other anthropometric parameters (weight, height and waist circumference - Table 2). There was also no difference between groups regarding the prevalence of elevated waist circumference and the prevalence of overweight/obesity (Table 3).

The analysis of metabolic variables showed that the group with the highest PWV tertile had higher mean insulin and HOMA-IR, and lower mean adiponectin levels (Table 2) when compared to the other groups. The third tertile group also showed a higher prevalence of diabetes mellitus/glucose intolerance (DM/GI) and hyperinsulinemia (Table 3).

Table 4 describes the univariate correlations of PWV with the study variables. A significant positive correlation with SBP, DBP, MBP, BMI, waist circumference, LDL-cholesterol, and a negative correlation with HDL-cholesterol and adiponectin can be observed. In the multivariate regression analysis, the inclusion of age, gender, BMI and blood pressure in the model with HDL-cholesterol, LDL-cholesterol and adiponectin, showed that PWV had a significant association only with the male gender and MBP (Table 5).






The present study demonstrated the association of PWV with a worse cardiovascular profile, especially regarding metabolic features, such as higher BP, BMI and insulin and lower plasma adiponectin levels, higher HOMA-IR index and prevalence of diabetes mellitus/glucose impairment (DM / GI) and hyperinsulinemia in young adults with the highest PWV tertile.

Age and blood pressure are the major determinants of PWV. It is believed that age-related vascular stiffening is accelerated by the chronic elevation of blood pressure caused by structural and functional changes in central elastic arteries.

In turn, arterial stiffening partly promotes changes in systolic and diastolic blood pressure related to age, particularly in older individuals5,21,22.

In individuals younger than 40 years, when the effects of aging on the arterial wall structure and consequent pattern of vascular stiffening is not yet fully developed, the conventional association between age and hypertension become less evident23, suggesting that the increased stiffness assessed by arterial PWV in young adults is influenced by other factors such as increased sympathetic nervous system activity and increased peripheral vascular resistance10.

In the present study, PWV showed a strong correlation with blood pressure, reflected by higher SBP, DBP, and MBP means in the group with the highest PWV tertile, as well as significant correlations of MBP with PWV, even after adjustments for age, gender and BMI.

Regarding age, the age range of the study population was too narrow and did not represent an important factor in the determination of PWV in the study population, showing no influence on the other study findings.

In relation to the anthropometric indices, this study showed a strong association of PWV with BMI and waist circumference. These findings are also in agreement with previous studies. Zebekakis et al24 demonstrated a strong correlation between PWV and high BMI and waist-hip ratio, regardless of age, gender, ethnicity and systolic blood pressure. Two other studies controlling the interference caused by age demonstrated positive associations between PWV and several obesity indices, both in a population with a wide age range (20-77 years)25 and in a younger population (36 years)26.

In the present study there was no difference between groups regarding associations either with the means or with the prevalence of possible abnormalities in lipid parameters; however, PWV significantly correlated with LDL-cholesterol and HDL-cholesterol.

The evidence on the correlation between arterial stiffness and lipid levels is controversial. Wang et al27 showed a positive association between PWV and total cholesterol and LDL-cholesterol and an inverse correlation with HDL-cholesterol, with no correlation between PWV and triglycerides (TG)27. On the other hand, Ferreira et al28 could not demonstrate an association between dyslipidemia (elevated TG and low HDL-cholesterol) with PWV in a population of young adult women, and a major population study6 did not identify any influence of dyslipidemia on PWV.

As this association appears to be complex, it is possible that several existing mechanisms for the association between plasma lipids and arterial stiffness involve situations and concomitant risk factors, such as the development of atherosclerotic plaques, oxidative stress, local and systemic inflammation, endothelial dysfunction, low bioavailability of nitric oxide and endothelin action29.

The group with the highest PWV tertile showed a higher prevalence of individuals with DM/GI, although there was no significant difference in the comparison of mean glucose levels between the groups. It is noteworthy that the group with the highest PWV tertile also showed higher serum insulin levels, higher prevalence of hyperinsulinemia and increased HOMA-IR.

Different authors have reported that PWV is higher in diabetic30 and glucose intolerant individuals31, regardless of BP levels and the patient's age32; however, no association has been demonstrated between arterial stiffening and normal fasting glucose levels33.

Reduced arterial elasticity can result from the direct action of hyperglycemia and/or hyperinsulinemia or may be a consequence of the action of advanced glycation end products on the vascular matrix proteins, with consequent increased production of collagen fibers30.

The role of insulin resistance in the pathogenesis of premature vascular sclerosis may be an important early feature of subclinical disease34. The increase of arterial stiffness is proportional to the degree of insulin resistance, regardless of age, degree of obesity, serum lipids and blood pressure, and can be one of the mechanisms involved in this association35, involving alterations such as endothelial dysfunction, inflammation and sympathetic activation28.

Importantly, this study demonstrated an association between lower levels of adiponectin and arterial stiffness assessed by PWV, with a strong inverse correlation between adiponectin levels and PWV. These data are consistent with Mahmud's findings36, which showed a significant inverse association between plasma adiponectin levels and PWV in hypertensive individuals and a negative association between adiponectin and plasma glucose, suggesting that insulin resistance, which admittedly increases PWV, may be one of the mechanisms36.

The discovery and study of adipokines, such as leptin and adiponectin, have contributed to the understanding of the role of the adipose tissue in the metabolic homeostasis. These molecules may play an important role in the development of insulin resistance and its consequences. Serum leptin concentrations have been associated with cardiovascular risk factors, hypertension and dyslipidemia. Adiponectin is an important insulin resistance-modulating adipokine with anti-inflammatory and anti-atherogenic properties37. Low concentrations of adiponectin are associated with the presence of cardiovascular risk factors38.

Windham et al39 demonstrated that leptin was involved in the association between abdominal obesity and arterial stiffness, and that there was a correlation, independent of leptin, adiponectin and resistin, with PWV.

Gauthier et al38 observed a positive association between PWV and leptin/adiponectin ratio adjusted for gender and age.

In this study, although BP greatly contributed to a higher PWV, metabolic variables such as HDL-cholesterol, LDL-cholesterol, insulin, HOMA-IR, glucose intolerance and hyperinsulinemia also correlated with PWV. These variables are pathophysiologically related, often coexist in young adults10 and are associated with arterial structure and function impairment40.

The cross-sectional nature of this study limits our ability to infer a causal relationship between the different variables analyzed and the measurement of arterial stiffness provided by PWV in young adults. Since this is an exploratory study that used several multivariate models to adjust the formulated hypotheses, it is estimated that some biases may have occurred. Thus, we believe that further studies are required to determine how the cardiovascular risk variables analyzed in this study contribute to determine arterial stiffness and, ultimately, to develop arteriosclerosis.

In conclusion, the results of this study demonstrated that the vascular involvement assessed by PWV in young individuals was significantly associated with BP, serum lipids, insulin and HOMA-IR, and adiponectin levels.

It is noteworthy that the male gender and mean blood pressure played an important role in the determination of higher PWV in young adults. These findings suggest that the noninvasive analysis of the vascular structure and function by measuring PWV can be useful for the identification of early vascular involvement in young individuals. Thus, the data shown here are added to previous studies which suggest that the structural integrity and stiffness of the arterial wall in young individuals are determined by several pathogenic mechanisms related to different cardiovascular risk factors, thereby creating a scenario of high potential for prevention in this age group.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Sources of Funding

There were no external funding sources for this study.

Study Association

This article is part of the thesis of doctoral submitted by Oswaldo Luiz Pizzi, from Universidade do Estado do Rio de Janeiro.



1. Juonala M, Jarvisalo MJ, Maki-Torkko N, Kahonen M, Viikari JS, Raitakari OT. Risk factors identified in childhood and decreased carotid artery elasticity in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation. 2005;112(10):1486-93.         [ Links ]

2. Deanfield JE, Halcox JP, Rabelink TJ. Endothelial function and dysfunction: testing and clinical relevance. Circulation. 2007;115(10):1285-95.         [ Links ]

3. Lakka H-M, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288(21):2709-16.         [ Links ]

4. Aatola H, Hutri-Kähönen N, Juonala M, Viikari JSA, Hulkkonen J, Laitinen T, et al. Lifetime risk factors and arterial pulse wave velocity in adulthood. Hypertension. 2010;55(3):806-11.         [ Links ]

5. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-605.         [ Links ]

6. The Reference Values for Arterial Stiffness Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. Eur Heart J. 2010;31(19):2338-50.         [ Links ]

7. Li S, Chen W, Srinivasan SR, Berenson GS. Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa Heart Study. Hypertension. 2004;43(3):541-6.         [ Links ]

8. Im JA, Lee JW, Shim JY, Lee HR, Lee DC. Association between brachial-ankle pulse wave velocity and cardiovascular risk factors in healthy adolescents. J Pediatr. 2007;150(3):247-51.         [ Links ]

9. Oren A, Vos LE, Uiterwaal CS, Gorissen WH, Grobbee DE, Bots ML. Adolescent blood pressure does not predict aortic stiffness in healthy young adults. The Atherosclerosis Risk in Young Adults (ARYA) study. J Hypertens. 2003;21(2):321-6.         [ Links ]

10. Bhuiyan AR, Srinivasan SR, Chen W, Paul TK, Berenson GS. Correlates of vascular structure and function measures in asymptomatic young adults: The Bogalusa Heart Study. Atherosclerosis. 2006;189(1):1-7.         [ Links ]

11. Rajzer MW, Klocek M, Kawecka-Jaszcz K, Czarnecka D, Baran W, Dudek K, et al. Aortic pulse wave velocity in young normotensives with a family history of hypertension. J Hypertens. 1999;17(12):1821-4.         [ Links ]

12. Muiesan ML, Salvetti M, Paini A, Monteduro C, Rosei CA, Aggiusti C, et al. Pulse wave velocity and cardiovascular risk stratification in a general population: the Vobarno study. J Hypertens. 2010;28(9):1935-43        [ Links ]

13. Brandao AP, Brandao AA, Araujo EM. The significance of physical development on the blood pressure curve of children between 6 and 9 years of age and its relationship with familial aggregation. J Hypertens. 1989;7(1):S37-9.         [ Links ]

14. Campana EM, Brandão AA, Pozzan R, França MF, Fonseca FL, Pizzi O, et al. Pressão arterial em jovens como marcador de risco cardiovascular. Arq Bras Cardiol. 2009;93(6):657-65.         [ Links ]

15. Pizzi O, Brandão AA, Pozzan R, Magalhães ME, Freitas EV, Brandão AP. Pulse wave velocity in young adults: study of Rio de Janeiro. Arq Bras Cardiol. 2011;97(1):53-8.         [ Links ]

16. Callaway CW, Chumlea WC, Bouchard C, Himes JH, Lohman TG, AD. M. Circumferences. In: Lohman TG, Roche AF, Martorell R. (editors). Anthropometric standardization reference manual: Champaign, IL: Human Kinetics; 1991. p. 39-54.         [ Links ]

17. Sociedade Brasileira de Cardiologia / Sociedade Brasileira de Hipertensão / Sociedade Brasileira de Nefrologia. VI Diretrizes brasileiras de hipertensão. Arq Bras Cardiol. 2010;95(1 supl.1):1-51.         [ Links ]

18. Sposito AC, Caramelli B, Fonseca FA, Bertolami MC, Afiune Neto A, Souza AD, et al.; Sociedade Brasileira de Cardiologia. IV Diretriz brasileira sobre dislipidemias e prevenção da aterosclerose. Arq Bras Cardiol. 2007;88(supl 1):1-18.         [ Links ]

19. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62-9.         [ Links ]

20. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1995;28(7):412-9.         [ Links ]

21. Asmar RG, Benetos A, Topouchian JP, Laurent P, Pannier B, Brisac AM, et al. Assesment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension. 1995;26(3):485-90.         [ Links ]

22. Najjar SS, Scuteri A, Shetty V, Wright JG, Muller DC, Fleg JL, et al. Pulse wave velocity is an independent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore Longitudinal Study of Aging. J Am Coll Cardiol. 2008;51(14):1377-83.         [ Links ]

23. Schillaci G, Pirro M, Vaudo G, Mannarino MR, Savarese G, Pucci G, et al. Metabolic syndrome is associated with aortic stiffness in untreated essential hypertension. Hypertension. 2005;45(6):1078-82.         [ Links ]

24. Zebekakis PE, Nawrot T, Thijs L, Balkestein EJ, van der Heijden-Spek J, Van Bortel LM, et al. Obesity is associated with increased arterial stiffness from adolescence until old age. J Hypertens. 2005;23(10):1839-46.         [ Links ]

25. Wildman RP, Mackey RH, Boston A, Thompson T, Sutton-Tyrrell K. Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension. 2003;42(4):468-73.         [ Links ]

26. Ferreira I, Twisk JW, van Mechelen W, Kemper HC, Seidell JC, Stehouwer CD. Current and adolescent body fatness and fat distribution: relationships with carotid intima-media thickness and large artery stiffness at the age of 36 years. J Hypertens. 2004;22(1):145-55.         [ Links ]

27. Wang F, Ye P, Luo L, Xiao W, Qi L, Bian S, et al. Association of serum lipids with arterial stiffness in a population-based study in Beijing. Eur J Clin Invest. 2011;41(9):929-36.         [ Links ]

28. Ferreira I, Boreham CA, Twisk JW, Gallagher AM, Young IS, Murray LJ, et al. Clustering of metabolic syndrome risk factors and arterial stiffness in young adults: the Northern Ireland Young Hearts Project. J Hypertens. 2007;25(5):1009-20.         [ Links ]

29. Wilkinson S, Cockroft J. Cholesterol and arterial stiffness. In: Safar M, Frohlich E. (editors). Atherosclerosis, large arteries and cardiovascular risk. Adv Cardiol. Basel: Karger; 2007. p. 261-77.         [ Links ]

30. Safar ME, Czernichow SB, Blacher J. Obesity, arterial stiffness, and cardiovascular risk. J Am Soc Nephrol. 2006;17(4 Suppl 2):S109-11.         [ Links ]

31. Ohnishi H, Saitoh S, Takagi S, Ohata J, Isobe T, Kikuchi Y, et al. Pulse wave velocity as an indicator of atherosclerosis in impaired fasting glucose: the Tanno and Sobetsu study. Diabetes Care. 2003;26(2):437-40.         [ Links ]

32. Chikako I. Effects of glucose intolerance on pulse wave velocity [abstract]. Jap J Clin Physiol. 1999;29(3):143-9.         [ Links ]

33. Li CH, Wu JS, Yang YC, Shih CC, Lu FH, Chang CJ. Increased arterial stiffness in subjects with impaired glucose tolerance and newly diagnosed diabetes but not isolated impaired fasting glucose. J Clin Endocrinol Metab. 2012;97(4):E658-62.         [ Links ]

34. Webb DR, Khunti K, Silverman R, Gray LJ, Srinivasan B, Lacy PS, et al. Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity. Diabetologia. 2010;53(6):1190-8.         [ Links ]

35. Ho CT, Lin CC, Hsu HS, Liu CS, Davidson LE, Li TC, et al. Arterial stiffness is strongly associated with insulin resistance in Chinese -- a population-based study (Taichung Community Health Study, TCHS). J Atheroscler Thromb. 2011;18(2):122-30.         [ Links ]

36. Mahmud A, Feely J. Adiponectin and arterial stiffness. Am J Hypertens. 2005;18(12 Pt 1):1543-8.         [ Links ]

37. Gil-Campos M, Canete RR, Gil A. Adiponectin, the missing link in insulin resistance and obesity. Clin Nutr. 2004;23(5):963-74.         [ Links ]

38. Gauthier A, Dubois S, Bertrais S, Gallois Y, Aube C, Gagnadoux F, et al. The leptin to adiponectin ratio is a marker of the number of metabolic syndrome criteria in French adults. J Metabolic Syn. 2012;1:101.         [ Links ]

39. Windham BG, Griswold ME, Farasat SM, Ling SM, Carlson O, Egan JM, et al. Influence of leptin, adiponectin, and resistin on the association between abdominal adiposity and arterial stiffness. Am J Hypertens. 2010;23(5):501-7.         [ Links ]

40. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a "set up" for vascular disease. Circulation. 2003;107(1):139-46.         [ Links ]



Mailing Address:
Oswaldo Luiz Pizzi •
Rua Francisco Framback, 17. Cascatinha - 25716-120 - Petrópolis, RJ, Brazil

Manuscript received May 10, 2012; revised manuscript received July 11, 2012; acepted July 30, 2012.

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