This study found that older age, especially >60 years, was associated with abnormal ABI, which is in agreement with previous reports by Ašćerić14 and Ozgur.15 The aging process could lead to accelerated atherosclerosis17 via vascular remodeling and insulin resistance, with a subsequent constellation of multiple cardiovascular risk factors, all of which have obesity in common as the main underlying factor.18,19 Hence, advanced age is clearly a risk factor for atherosclerosis, particularly if obesity is present. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.