title: Asymmetric dimethylarginine and all-cause mortality: a systematic review and meta-analysis.
abstract: Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase (NOS), impairs the beneficial effect of NO. The predictive value of ADMA for all-cause mortality remains controversial, though it is important in the development of cardiovascular disease (CVD) and progression to dialysis in renal disease. This systematic review and meta-analysis was conducted to investigate the association between circulating ADMA and all-cause mortality. Studies with data pertinent to the association between circulating ADMA and all-cause mortality were reviewed and OR, HR or RR with 95% CI derived from multivariate Cox's proportional-hazards analysis were extracted. A total of 34 studies reporting 39137 participants were included in final analysis. The results demonstrated that circulating ADMA was independently associated with all-cause mortality (RR = 1.27, 95% CI: 1.20-1.34). The association was still statistically significant in patients with pre-existing renal disease (RR = 1.30, 95% CI: 1.19-1.43) and pre-existing CVD (RR = 1.26, 95% CI: 1.16-1.37). In those without pre-existing renal or CVD, ADMA also predicted all-cause mortality (RR = 1.31, 95% CI: 1.13-1.53). The present study suggests a positive association of circulating ADMA with all-cause mortality. Further studies are needed to investigate the effects of interventions on ADMA, and the value of ADMA as a biomarker.
authors.affiliation: Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
authors.forename: Shaoli
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
authors.forename: Chaojin
authors.initials: C
authors.lastname: Chen
authors.affiliation: Foshan Women and Children's Healthcare Hospital, Foshan City, People's Republic of China.
authors.forename: Jiping
authors.initials: J
authors.lastname: Liu
authors.affiliation: Foshan Women and Children's Healthcare Hospital, Foshan City, People's Republic of China.
authors.forename: Yuping
authors.initials: Y
authors.lastname: Ye
authors.affiliation: Department of Thyroid and Breast Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, People's Republic of China.
authors.forename: Ziqing
authors.initials: Z
authors.lastname: Hei
mesh_terms: D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D009569:Nitric Oxide / Q000097:blood; D019001:Nitric Oxide Synthase / Q000097:blood; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors
chemical_list: D015415:Biomarkers; C487735:dimethylarginine; D009569:Nitric Oxide; D001120:Arginine; D019001:Nitric Oxide Synthase