From the Research
Elevated Asymmetric Dimethylarginine (ADMA) levels are a significant predictor of adverse cardiovascular events and mortality, and should be addressed through lifestyle modifications and potential pharmacological interventions to improve endothelial function and reduce cardiovascular risk. To interpret elevations in ADMA:
- Consider ADMA levels above 0.5 μmol/L as elevated, as seen in studies such as 1.
- Evaluate for underlying cardiovascular risk factors or diseases, as elevated ADMA levels are associated with increased cardiovascular risk and endothelial dysfunction 2, 3.
- Assess renal function, as impaired kidney function can lead to ADMA accumulation, and optimize kidney function if necessary 2.
- Look for signs of endothelial dysfunction or atherosclerosis, as ADMA inhibits nitric oxide synthase, reducing nitric oxide production and impairing vascular function 4, 5.
- Consider lifestyle modifications, such as regular exercise, balanced diet, and smoking cessation, to improve endothelial function and reduce cardiovascular risk.
- Consider medications that may improve endothelial function, such as ACE inhibitors or statins, if clinically indicated, as well as supplemental citrulline, which may help offset the suppressive impact of ADMA on eNOS activity 3. Key points to consider:
- Elevated ADMA levels are associated with increased cardiovascular risk and endothelial dysfunction, and are a significant predictor of adverse cardiovascular events and mortality 2, 5, 1.
- ADMA inhibits nitric oxide synthase, reducing nitric oxide production and impairing vascular function, which contributes to cardiovascular disease progression 4.
- The arginine:ADMA ratio is of clinical importance, and restoring this ratio may help improve clinical outcomes in critically ill patients 4.
- Large and long-term clinical trials are needed to evaluate the potential of citrulline supplementation in patients with elevated ADMA levels and high cardiovascular risk 3.