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01.03.2013 | Original Paper

Asymmetric and symmetric dimethylarginine and risk of secondary cardiovascular disease events and mortality in patients with stable coronary heart disease: the KAROLA follow-up study

verfasst von: Bob Siegerink, Renke Maas, Carla Y. Vossen, Edzard Schwedhelm, Wolfgang Koenig, Rainer Böger, Dietrich Rothenbacher, Hermann Brenner, Lutz P. Breitling

Erschienen in: Clinical Research in Cardiology | Ausgabe 3/2013

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Abstract

Background

Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor, which has been associated with total and cardiovascular mortality in various clinical settings. Studies on its structural isomer, symmetric dimethylarginine (SDMA), are scarce. This study aimed to determine the associations of both ADMA and SDMA levels with secondary cardiovascular disease events and all-cause mortality in patients with stable coronary heart disease (CHD).

Methods

In the observational prospective cohort study KAROLA, 1,148 CHD patients were followed for a median of 8.1 years. ADMA and SDMA were determined by liquid chromatography–tandem mass spectrometry. Baseline ADMA and SDMA levels were categorized in quartiles or standardized by their respective standard deviation, and appropriate hazard ratios and 95 % confidence intervals (HR [95 % CI]) were estimated in Cox proportional hazards models.

Results

150 patients experienced secondary cardiovascular disease events (CVD) and 121 patients died. After adjustment for confounders, ADMA was not associated with the risk of secondary CVD events (HR per standard deviation increase: 1.02 [95 %CI: 0.86–1.21]), whereas an association was suggested for SDMA (HR 1.17 [1.00–1.37]). Higher hazard ratios were observed in all-cause mortality models (ADMA: HR 1.15 [0.95–1.37]; SDMA: HR 1.29 [1.09–1.52]).

Conclusions

Our results suggest that especially SDMA might possibly have potential as a risk marker for all-cause mortality and to a lesser extent for secondary cardiovascular events. Future studies are needed to quantify these associations more precisely and should, in particular, further address the possibility of residual confounding by impaired kidney function.

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Titel: Asymmetric and symmetric dimethylarginine and risk of secondary cardiovascular disease events and mortality in patients with stable coronary heart disease: the KAROLA follow-up study
verfasst von: Bob Siegerink
Renke Maas
Carla Y. Vossen
Edzard Schwedhelm
Wolfgang Koenig
Rainer Böger
Dietrich Rothenbacher
Hermann Brenner
Lutz P. Breitling
Publikationsdatum: 01.03.2013
Verlag: Springer-Verlag
Erschienen in: Clinical Research in Cardiology / Ausgabe 3/2013
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-012-0515-4

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Asymmetric and symmetric dimethylarginine and risk of secondary cardiovascular disease events and mortality in patients with stable coronary heart disease: the KAROLA follow-up study