title: Association between Body Mass Index, Asymmetric Dimethylarginine and Risk of Cardiovascular Events and Mortality in Norwegian Patients with Suspected Stable Angina Pectoris.
abstract: BACKGROUND
  Asymmetric dimethylarginine (ADMA) is associated with increased risk of atherosclerotic cardiovascular disease and mortality through inhibition of nitrogen oxide (NO) synthesis. As positive correlations between serum concentrations of NO and body mass index (BMI) have been observed, we aimed to explore whether the potential associations between plasma ADMA levels and the risk of acute myocardial infarction (AMI) and mortality were modified by BMI.
  
  
  METHODS
  Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HR) for AMI, cardiovascular death and all-cause mortality according to baseline plasma ADMA levels in 4122 patients with suspected stable angina pectoris. Analyses were subsequently repeated in patients with BMI below (low BMI) or above (high BMI) median.
  
  
  RESULTS
  A total of 2982 patients (72%) were men. Median (range) age, plasma ADMA level and BMI were 62 (21-88) years, 0.54 (0.10-1.25) μmol/L and 26.3 (18.5-54.3) kg/m2, respectively. During a mean (standard deviation) follow-up time of 4.7 (1.4) years, 337 (8%) patients suffered from an AMI, 300 (7%) died, whereof 165 (55%) due to cardiovascular disease. Each 0.1 μmol/L increment in plasma ADMA level was associated with an increased risk of AMI (HR (95% CI) 1.21 (1.08, 1.35) and cardiovascular death 1.30 (1.13, 1.49) in participants with low BMI only. Interactions were significant for AMI (p = 0.04) and CV death (p = 0.03). BMI did not modify the association between plasma ADMA levels and all-cause mortality.
  
  
  CONCLUSIONS
  Plasma ADMA levels were associated with risk of AMI and cardiovascular death among patients with low BMI only.
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.|Department of Endocrinology, Morbid Obesity and Preventive Medicine Institute of Clinical Medicine University of Oslo, Oslo, Norway.
authors.forename: Heidi
authors.initials: H
authors.lastname: Borgeraas
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Jens Kristoffer
authors.initials: JK
authors.lastname: Hertel
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Gard Frodahl Tveitevåg
authors.initials: GF
authors.lastname: Svingen
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Eva Ringdal
authors.initials: ER
authors.lastname: Pedersen
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Seifert
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.|Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.|KG Jebsen Center for Diabetes Research, Haukeland University Hospital, Bergen, 5021, Norway.
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.|Department of Endocrinology, Morbid Obesity and Preventive Medicine Institute of Clinical Medicine University of Oslo, Oslo, Norway.
authors.forename: Jøran
authors.initials: J
authors.lastname: Hjelmesæth
mesh_terms: D060050:Angina, Stable / Q000097:blood* / Q000378:metabolism / Q000503:physiopathology; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000378:metabolism / Q000503:physiopathology*; D009589:Nitrogen Oxides / Q000378:metabolism; D009664:Norway; D012307:Risk Factors
chemical_list: D009589:Nitrogen Oxides; C018524:N,N-dimethylarginine; D001120:Arginine