Background: Obesity in adolescents has quadrupled in the past 30 y. Markers for cardiovascular risks are needed in this population. We hypothesized that soluble receptor for advanced glycation end products (sRAGE) and asymmetric dimethyl arginine (ADMA) can correlate with carotid intimamedia thickness (cIMT), a known index of subclinical atherosclerosis. We also aimed to evaluate the frequency of (Gly82Ser) RAGE gene polymorphism in obese adolescents. Methods: Obese and nonobese adolescents were evaluated in a cross-sectional study for lipid profile, insulin resistance, ADMA, sRAGE, and RAGE gene (Gly 82 Ser) polymorphism. We measured cIMT in all subjects and performed correlation analyses with all markers. results: The study included 50 obese and 40 healthy control adolescents. Compared to controls, obese subjects had less sRAGE (P = 0.02) and greater cIMT (P = 0.006), insulin resistance (P < 0.0001), and ADMA (P < 0.0001). In a multivariate linear regression model, sRAGE was associated with cIMT (β = 0.28, P = 0.04). Both GS and SS genotypes of RAGE were more frequent in obese than controls (P = 0.04). conclusion: Increased ADMA and decreased sRAGE are associated with cardiovascular risks in obese adolescents. The S allele in RAGE gene is more frequently detected with obesity. The role of RAGE gene and mechanisms leading to cardiovascular risks need further studying. c hildhood obesity is an emerging public health challenge with an estimated prevalence of around 20% in western countries (1). Exposure to cardiovascular risk factors in early life, including obesity, may induce changes in the arteries that are associated with the diagnosis of atherosclerosis in adults (2). The measurement of carotid intimamedia thickness (cIMT) is a noninvasive test to detect early alterations in arterial wall and can be a useful screening tool to early assess subclinical manifestations of cardiovascular and metabolic diseases (3). However, there is a desperate need to discover novel biomarkers that can help understand the exact pathophysiology and improve clinical management of cardiovascular diseases associated with obesity in children (4).Asymmetric dimethyl arginine (ADMA) is a competitive inhibitor of endothelial nitric oxide (NO) synthase that reduces the production of NO and therefore might cause endothelial dysfunction. Serum ADMA concentrations are increased in individuals with hypercholesterolemia, atherosclerosis, hypertension, chronic heart failure, diabetes mellitus, and chronic renal failure. It has been suggested as a potential risk predictor for cardiovascular events and all-cause cardiovascular mortality in patients with coronary artery disease (5). The relationship between ADMA and cardiovascular complications in children remains unclear.The advanced glycation end products (AGE) and its receptor (RAGE) system is a newly discovered pathway implicated in the pathogenesis of several cardio-metabolic diseases (6). The RAGE is a multiligand receptor of the immunoglobulin superfamily of cell surface molecules and enga...