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European Heart Journal Advance Access published online on April 28, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi287
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received September 14, 2004
Revised January 21, 2005
Accepted March 24, 2005

Clinical research

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

Tanja K. Krempl 1*, Renke Maas 2, Karsten Sydow 3, Thomas Meinertz 4, Rainer H. Böger 2, and Jan Kähler 4

1 Institute of Experimental and Clinical Pharmacology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Department of Cardiology and Angiology, Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
2 Institute of Experimental and Clinical Pharmacology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
3 Vascular Medicine and Biology, Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
4 Department of Cardiology and Angiology, Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany

* To whom correspondence should be addressed.
Tanja K. Krempl, E-mail: t.krempl{at}uke.uni-hamburg.de


  Abstract

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 µmol/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 µmol/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 µmol/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.

Keywords: Asymmetric dimethylarginine; Nitric oxide; Coronary artery disease.
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