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Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase, and it may predict cardiovascular and all-cause mortality. Here we examined the prognostic value of serum levels of ADMA in patients with stable coronary heart disease.
In this prospective nested case-control study, 36 of 1,503 Chinese patients with stable coronary heart disease experienced at least one recurrent cardiovascular event (RCE), defined as cardiac death, nonfatal myocardial infarction or ischemic stroke during 1-year follow-up. Serum levels of ADMA at the start of follow-up were compared between these 36 cases and 36 controls who did not experience an RCE and who were matched to cases in terms of gender, age, and history of hypertension, diabetes, and myocardial infarction. Data were analyzed using crude, case-mix adjusted, and multivariable adjusted models.
Based on the crude model, subjects in the two highest ADMA quartiles showed significantly higher risk of developing RCE than those in the lowest ADMA quartile (OR 4.09, 95%CI 1.01 to 16.58; OR 6.76, 95%CI 1.57 to 29.07). This association was also observed in the case-mix model (OR 5.51, 95%CI 1.23 to 24.61; OR 7.83, 95%CI 1.68 to 36.41) and multivariable model (OR 6.64, 95%CI 1.40 to 31.49; OR 13.14, 95%CI 2.28 to 75.71) after adjusting for confounders. The multivariable model which combined ADMA and hsCRP showed better predictive power with areas under the receiver operator characteristic (ROC) curves (0.779) than the model of either ADMA (0.694) or hsCRP (0.636).
Serum ADMA levels may be a potential biomarker in predicting one-year RCE in patients with stable coronary heart disease. Moreover, it provides additional and associated prognostic value to hs-CRP in this cohort.