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Some time ago the Journal published an article by us entitled ‘‘Relationship between leptin and body mass and metabolic syndrome in an adult population’’ (Rev Port Cardiol 2012;31 11:711-719), which was the subject of a Letter to the Editor from investigators in Turkey. We are pleased to note that some of the comments in this letter were in support of our article, which we appreciate, while others are somewhat critical. These criticisms appear to apply to the title of our article, since we correlated body mass index (BMI) with leptin levels without taking into consideration the effect of smoking as a cardiovascular risk factor, which can affect serum leptin levels. We used BMI as a means of quantifying obesity, which we proceeded to relate to the risk factors under analysis. With regard to the title of the Letter to the Editor, we would like to make the following points. Obesity, in particular changes in adipose tissue, has harmful effects in organs including the pancreas, liver, muscle and especially the heart. Insulin resistance (IR) is the main mechanism behind these effects, resulting in other disorders including dyslipidemia, hyperinsulinemia and impaired glucose tolerance (as we observed in our study population and attempted to explain), leading inexorably to atherosclerosis (and hence cardiovascular disease) and type 2 diabetes. As stated in the Results and Discussion sections of our article, higher serum leptin levels are associated with significantly increased IR and serum insulin (and in fact with all the

Reply to the Letter to the Editor “Are leptin levels a cause or an indicator of cardiovascular risk?”