Relationship of baseline plasma ADMA levels to cardiovascular outcomes at 2 years in men with acute coronary syndrome referred for coronary angiography
Relationship of baseline plasma ADMA levels to cardiovascular outcomes at 2 years in men with acute coronary syndrome referred for coronary angiography
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DOI：
10.1097/mca.0b013e328323982f
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发表时间：
2009-03-01
影响因子：
1.8
通讯作者：
Marmur, Jonathan D.
中科院分区：
文献类型：
--
作者：
Cavusoglu, Erdal;Ruwende, Cyril;Marmur, Jonathan D.
背景一氧化氮(NO)是由L-精氨酸合成的一氧化氮合酶产物，是一种具有抗动脉粥样硬化作用的重要分子。不对称二甲基精氨酸(ADMA)是内皮型一氧化氮合酶的内源性抑制物。因此，它与内皮功能障碍有关，在有心血管危险因素的患者中发现循环中ADMA水平升高。此外，在各种患者群体中，高基线血浆ADMA水平已被证明是不良结局的独立预测因子。然而，关于急性冠脉综合征(ACS)患者的数据非常有限。方法本研究调查了193名接受冠状动脉造影的男性急性冠脉综合征患者的基线血浆ADMA水平对长期预后的意义。结果在控制了各种基线变量(包括已建立的生物标志物，如高敏C反应蛋白和纤维蛋白原)后，血浆ADMA水平(分析为基准值的上三分位数，而不是基准值的下三分位数)是全因死亡率的每个单独终点的强大而独立的预测因子[危险比(HR)：2.45，95%可信区间(CI)：1.0 8-5.5 7；P=0.03251；心肌梗死(HR：2.2 8，95%CI：1.14-4.5 7；P=0.0204)。此外，基线ADMA值也是全因死亡率、致命性或非致命性心肌梗死或卒中的综合预后的独立预测因子(HR：1.81，95%CI：1.01~3.25；P=0.0482)。科隆动脉DIS 20：112-117(C)2009 Wolters Kluwer Health|Lippincott Williams&Wilkins。
Background Nitric oxide (NO) is produced from L-arginine by NO synthase and is an important molecule with antiatherogenic properties. Asymmetric dimethylarginine (ADMA) acts as an endogenous inhibitor of endothelial NO synthase. As such, it has been associated with endothelial dysfunction and elevated circulating levels of ADMA have been found in patients with cardiovascular risk factors. In addition, high baseline plasma levels of ADMA have been shown to be an independent predictor of adverse outcomes in a variety of patient populations. However, there are very limited data in patients with acute coronary syndromes (ACS).Methods This study investigated the long-term prognostic significance of baseline plasma ADMA levels in a well-characterized cohort of 193 men with ACS who were referred for coronary angiography. All patients were followed up prospectively for the development of vascular outcomes.Results After controlling for a variety of baseline variables (including established biomarkers such as high-sensitivity C-reactive protein and fibrinogen), plasma ADMA levels (analyzed as the upper tertile of baseline values compared with the lower two tertiles) were a strong and independent predictor of each of the individual endpoints of all-cause mortality [hazard ratio (HR): 2.45, 95% confidence interval (Cl): 1.08-5.57; P=0.03251 and myocardial infarction (H R: 2.28, 95% Cl: 1.14-4.57; P=0.0204) when using a Cox proportional hazards model. In addition, baseline ADMA values were also an independent predictor of the composite outcome of all-cause mortality, fatal or nonfatal myocardial infarction, or stroke (HR: 1.81, 95% Cl: 1.01-3.25; P=0.0482).Conclusion These data show that elevated baseline levels of ADMA are a strong and independent predictor of cardiovascular outcomes (including mortality) in patients with ACS. Coron Artery Dis 20:112-117 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.