Purpose: Metabolic syndrome is associated with increased cardiovascular risk, hypertension, dyslipidemia and diabetes mellitus. Th e present study explores the relationship between body mass index (BMI), parameters of arterial stiff ness (aortic pulse wave velocity – PWV, central augmentation index), and subclinical atherosclerosis (carotid intima-media thickness IMT), with biomarkers of infl ammation and calcifi cation in obese patients with metabolic syndrome. Methods: The cross-sectional study was conducted in the Clinic of Cardiovascular Prevention of the Institute of Cardiovascular Diseases Timișoara, Romania, between June 2012 – June 2013, on 82 consecutive patients with obesity and metabolic syndrome, and a control lot of 74 healthy subjects. We assessed PWV using the occlusive device Arteriograph (Tensiomed Ltd., Budapest, Hungary) and carotid IMT by high resolution B-mode ultrasound according to the Mannheim Consensus. Osteoprotegerin (OPG), the receptor activator of nuclear factor kappa-B ligand (RANKL) and high sensitivity C reactive protein (hsCRP) were determined by ELISA. Results: Significantly increased values of OPG (3.8 ± 0.5 vs 1.2 ± 0.36, p < 0.001) and decreased values of RANKL (0.7 ± 0.64 vs 2.0 ± 0.11, p < 0.001) were observed in obese patients compared to control. A statistically significant positive correlation was observed between BMI and OPG (r = 0.803, p < 0.001) and a negative one with RANKL (r = -0.385, p < 0.001). BMI was signifi cantly correlated with PWV (r = 0.710, p <0.001), carotid IMT (r = 0.601, p < 0.001) and hsCRP (r = 0.594, p < 0.001). Conclusions: Obesity defi ned by BMI is correlated with arterial calcifi cation, suggesting a complex interaction between adiposity, infl ammation, and arterial stiff ness in the metabolic syndrome.