Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events

Aims We investigated the role of asymmetric dimethylarginine (ADMA) for clinical outcome of patients with unstable angina. Methods and results Forty-five patients with stable angina, 36 patients with unstable angina, and 40 healthy controls were included in this study. Coronary artery disease (CAD) patients were prospectively followed for 1 year. ADMA levels were measured at baseline and after 6 weeks using a validated ELISA. Baseline ADMA concentration in controls was significantly lower than in patients with CAD (0.59 +/- 0.23 vs. 0.76 +/- 0.17 mu mol/L; P < 0.001). Patients with unstable angina had significantly higher baseline ADMA levels than patients with stable angina (0.82 +/- 0.18 vs. 0.73 +/- 0.15 mu mol/L; P=0.01). There was a significant reduction of ADMA levels at 6 weeks after percutanous coronary intervention (PCI) in patients with unstable angina who experienced no recurrent cardiovascular event (from 0.81 +/- 0.14 to 0.73 +/- 0.19 mu mol/L; P < 0.05). In contrast, patients with unstable angina who had an event showed no significant decrease in ADMA at 6 weeks. Actuarial survival analysis showed a significantly higher event rate in patients with persistently elevated ADMA plasma concentrations. Conclusion ADMA is significantly elevated in patients with unstable angina. A reduced ADMA level at 6 weeks after PCI may indicate a decreased risk of recurrent cardiovascular events.