From the Research
Elevated Asymmetric Dimethylarginine (ADMA) blood levels are a significant biomarker for endothelial dysfunction and cardiovascular risk, and their management should focus on treating underlying conditions to reduce morbidity, mortality, and improve quality of life. ADMA is an endogenous inhibitor of nitric oxide synthase, the enzyme responsible for producing nitric oxide, which is essential for proper blood vessel function and dilation 1. When ADMA levels are elevated in the bloodstream, nitric oxide production decreases, leading to impaired vasodilation, increased vascular resistance, and potential hypertension. This biomarker is particularly relevant in patients with chronic kidney disease, diabetes, coronary artery disease, and heart failure, where elevated levels correlate with worse outcomes and increased mortality risk 2, 3. The significance of high ADMA extends beyond cardiovascular implications, as it has also been associated with progression of kidney disease, insulin resistance, and systemic inflammation 4.
Some key points to consider about ADMA include:
- ADMA is a marker of cardiovascular risk, and elevated levels are associated with increased risk of major adverse cardiovascular events 5
- ADMA levels are increased in patients with hypercholesterolemia, atherosclerosis, hypertension, chronic renal failure, chronic heart failure, and other clinical conditions 2
- The association between elevated ADMA levels and major cardiovascular events and total mortality is robust and extends to diverse patient populations 3
- Management of elevated ADMA levels focuses on treating underlying conditions through lifestyle modifications (diet, exercise, smoking cessation) and appropriate medical therapy for conditions like hypertension or hyperlipidemia 1
In terms of clinical practice, regular monitoring of ADMA levels may be valuable in high-risk patients to assess treatment efficacy and disease progression, though it is not yet routinely measured in standard clinical practice 4. Overall, the evidence suggests that elevated ADMA levels are a significant risk factor for cardiovascular disease and mortality, and their management should be a priority in patients with underlying cardiovascular conditions.