Asymmetric Dimethylarginine, Plasma
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Asymmetric dimethylarginine (ADMA) is an independent risk factor for coronary heart disease.(1) ADMA inhibits nitric oxide (NO) synthesis and is elevated in diseases related to endothelial dysfunction including hypertension, hyperlipidemia, and type-II diabetes mellitus. Elevation in ADMA and subsequent NO synthesis inhibition leads to vasoconstriction, reduced peripheral blood flow, and reduced cardiac output.
Elevated plasma ADMA confers a 4- to 6-fold increased risk of subsequent cardiovascular events or mortality among patients with acute coronary syndrome (2), unstable angina (3), type-II diabetes mellitus (4), end-stage renal disease (5), and coronary heart disease.(6) Among patients with coronary heart disease, baseline ADMA remained a significant risk factor of adverse events even after adjusting for LDL-C, HDL-C, triglycerides, creatinine and high sensitivity C–reactive protein.
Plasma ADMA concentrations are lowered by rosuvastatin and atorvastatin, but not simvastatin in patients with hypercholesterolemia.(7) Addition of vildagliptin (Galvus) to metformin significantly reduced ADMA concentrations among patients with type-II diabetes mellitus.(8)
An adjunct to other risk markers for assessing an individual's likelihood of future coronary events, in patients with coronary heart disease, type-II diabetes mellitus, or kidney disease
In patients with pre-existing coronary conditions or at high risk for coronary events (diabetes, renal insufficiency), asymmetric dimethylarginine (ADMA) levels in the upper tertile, >112 ng/mL, confer an increased risk for future coronary events.
Reductions in ADMA are not known to be predictive of decreased risk of future coronary effects.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
The test has no value in patients who smoke. Elevated values should not be used to diagnose the presence of disease or events.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
<18 years: not established
> or =18 years: 63-137 ng/mL
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Schulze F, Lenzen H, Hanefeld C, et.al: Asymmetric dimethylarginine is an independent risk factor for coronary heart disease: results from the multicenter Coronary Artery Risk Determination investigating the Influence of ADMA Concentration (CARDIAC) study. Am Heart J 2006 Sep;152(3):493.e1-8
2. Cavusoglu E, Ruwende C, Chopra V, et al: Relationship of baseline plasma ADMA levels to cardiovascular outcomes at 2 years in men with acute coronary syndrome referred for coronary angiography. Coron Artery Dis 2009;20:112-117
3. Krempl TK, Maas R, Sydow K, et al: Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events. Eur Heart J 2005;26:1846-1851
4. Cavusoglu E, Ruwende C, Chopra V, et al: Relation of baseline plasma ADMA levels to cardiovascular morbidity and mortality at two years in men with diabetes mellitus referred for coronary angiography. Atherosclerosis. 2010 May;210(1):226-231
5. Abedini S, Meinitzer A, Holme I, et al: Asymmetrical dimethylarginine is associated with renal and cardiovascular outcomes and all-cause mortality in renal transplant recipients. Kidney Int 2010 Jan;77(1):44-50
6. Valkonen VP, Paiva H, Salonen JT, et al: Risk of acute coronary events and serum concentration of asymmetrical dimethylarginine. Lancet 2001;358:2127-2128
7. Kurtoglu E, Sevket B, Sincer I, et al: Comparison of effects of Rosuvastatin versus Atorvastatin treatment on plasma levels of asymmetric dimethylarginine in patients with hyperlipidemia having coronary artery disease. Angiology 2014; 65:788-793
8. Cakirca M, Karatoprak C, Zorlu M, et al: Effect of vildagliptin add-on treatment to metformin on plasma asymmetric dimethylarginine in type 2 diabetes mellitus patients. Drug Des Devel Ther 2014;8:239-243