title: Oral L-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass.
abstract: It is known that L-arginine treatment can ameliorate endothelial dysfunction and insulin sensitivity in type 2 diabetes mellitus patients, but little is known on L-arginine effects on these variables in nondiabetic patients with stable cardiovascular disease (coronary artery disease). We evaluated the effects of long-term oral L-arginine treatment on endothelial dysfunction, inflammation, adipokine levels, glucose tolerance, and insulin sensitivity in these patients. Sixty-four patients with cardiovascular disease previously submitted to an aortocoronary bypass and not known for type 2 diabetes mellitus had an oral glucose load to define their glucose tolerance. Thirty-two patients with nondiabetic response were eligible to receive, in a double-blind randomized parallel order, L-arginine (6.4 g/d) or placebo for 6 months. An evaluation of insulin sensitivity index during the oral glucose load, markers of systemic nitric oxide bioavailability and inflammation, and blood flow was performed before and at the end of the treatment in both groups. Compared with placebo, L-arginine decreased asymmetric dimethylarginine levels (P < .01), indices of endothelial dysfunction, and increased cyclic guanosine monophosphate (P < .01), L-arginine to asymmetric dimethylarginine ratio (P < .0001), and reactive hyperemia (P < .05). Finally, L-arginine increased insulin sensitivity index (P < .05) and adiponectin (P < .01) and decreased interleukin-6 and monocyte chemoattractant protein-1 levels. In conclusion, insulin resistance, endothelial dysfunction, and inflammation are important cardiovascular risk factors in coronary artery disease patients; and L-arginine seems to have anti-inflammatory and metabolic advantages in these patients.
authors: Internal Medicine Department, Cardio-Diabetes Trials Unit, Scientific Institute San Raffaele, 20132 Milan, Italy. piatti.piermarco@hsr.it
authors: Pietro
authors: P
authors: Lucotti
authors: Lucilla
authors: L
authors: Monti
authors: Emanuela
authors: E
authors: Setola
authors: Giovanni
authors: G
authors: La Canna
authors: Alessandro
authors: A
authors: Castiglioni
authors: Alessandra
authors: A
authors: Rossodivita
authors: Maria Grazia
authors: MG
authors: Pala
authors: Francesco
authors: F
authors: Formica
authors: Giovanni
authors: G
authors: Paolini
authors: Alberico Luigi
authors: AL
authors: Catapano
authors: Emanuele
authors: E
authors: Bosi
authors: Ottavio
authors: O
authors: Alfieri
authors: Piermarco
authors: P
authors: Piatti
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001120:Arginine / Q000008:administration & dosage* / Q000494:pharmacology; D002318:Cardiovascular Diseases / Q000150:complications / Q000178:diet therapy* / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000534:rehabilitation*; D019587:Dietary Supplements; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000517:prevention & control*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010919:Placebos
chemical_list: D010919:Placebos; D001120:Arginine