title: Asymmetrical dimethylarginine independently predicts total and cardiovascular mortality in individuals with angiographic coronary artery disease (the Ludwigshafen Risk and Cardiovascular Health study).
abstract: BACKGROUND
  Asymmetrical dimethylarginine (ADMA) is increased in conditions associated with increased risk of atherosclerosis. We investigated the use of ADMA to predict total and cardiovascular mortality in patients scheduled for coronary angiography.
  
  
  METHODS
  In 2543 persons with and 695 without coronary artery disease (CAD) identified by angiography we measured ADMA and recorded total and cardiovascular mortality during a median follow-up of 5.45 years.
  
  
  RESULTS
  ADMA was correlated positively to age, female sex, diabetes mellitus, former and current smoking, and C-reactive protein and inversely to HDL cholesterol and triglycerides. ADMA was not associated with body mass index, hypertension, LDL cholesterol, or the presence or absence of angiographic CAD. Glomerular filtration rate and homocysteine were the strongest predictors of ADMA. At the 2nd, 3rd and 4th quartile of ADMA, hazard ratios for all-cause mortality adjusted for age, sex, and cardiovascular risk factors were 1.12 [95% confidence interval (CI) 0.83-1.52], 1.35 (95% CI 1.01-1.81), and 1.87 (95% CI 1.43-2.44), respectively, compared with the 1st quartile. Hazard ratios for cardiovascular death were 1.13 (95% CI 0.78-1.63), 1.42 (95% CI 1.00-2.02), and 1.81 (95% CI 1.31-2.51). ADMA in the highest quartile remained predictive of mortality after accounting for medication at baseline. The predictive value of ADMA was similar to that in the entire cohort in persons with CAD, stable or unstable, but was not statistically significant in persons without angiographic CAD.
  
  
  CONCLUSIONS
  ADMA concentration predicts all-cause and cardiovascular mortality in individuals with CAD independently of established and emerging cardiovascular risk factors.
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meinitzer
authors.forename: Ursula
authors.initials: U
authors.lastname: Seelhorst
authors.forename: Britta
authors.initials: B
authors.lastname: Wellnitz
authors.forename: Gabriele
authors.initials: G
authors.lastname: Halwachs-Baumann
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Boehm
authors.forename: Bernhard R
authors.initials: BR
authors.lastname: Winkelmann
authors.forename: Winfried
authors.initials: W
authors.lastname: März
mesh_terms: D000704:Analysis of Variance; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine