title: Raised plasma levels of asymmetric dimethylarginine are associated with cardiovascular events, disease activity, and organ damage in patients with systemic lupus erythematosus.
abstract: BACKGROUND
  Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide inhibitor and a new independent risk factor for endothelial dysfunction and cardiovascular disease.
  
  
  OBJECTIVE
  To investigate the relationship between plasma ADMA levels and cardiovascular events (CVEs) and disease characteristics in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Demographic and clinical data were collected and plasma ADMA levels were measured in 107 patients with SLE. A modified organ damage index was calculated as defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), excluding CVE as an item.
  
  
  RESULTS
  Cardiovascular disease, defined as > or =1 previous arterial CVE, was recorded in 16/107 (15%) patients with SLE and increased across tertiles of ADMA levels (p = 0.023 for trend). Mean plasma ADMA levels were significantly higher in patients with SLE with a history of CVEs than in patients without a CVE history (p = 0.018). In multiple regression analysis a high SLEDAI score, high modified SDI, high titre of anti-dsDNA antibodies, and low serum HDL were significantly associated with high plasma ADMA levels.
  
  
  CONCLUSIONS
  In patients with SLE, plasma ADMA levels are significantly associated with CVEs, measures of disease activity, and organ damage, independently of an unfavourable lipid profile.
authors.affiliation: Department of Rheumatology, VU University Medical Centre, Postbus 7057, 1007 MB, Amsterdam, The Netherlands. iem_bultink@hotmail.com
authors.forename: I E M
authors.initials: IE
authors.lastname: Bultink
authors.forename: T
authors.initials: T
authors.lastname: Teerlink
authors.forename: J A
authors.initials: JA
authors.lastname: Heijst
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: A E
authors.initials: AE
authors.lastname: Voskuyl
mesh_terms: D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D019001:Nitric Oxide Synthase / Q000037:antagonists & inhibitors; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine; D019001:Nitric Oxide Synthase