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10.1186/s12933-017-0569-8

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suck abstract from ncbi


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pmid28697799      Cardiovasc+Diabetol 2017 ; 16 (ä): ä
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  • Symmetric and asymmetric dimethylarginine as risk markers of cardiovascular disease, all-cause mortality and deterioration in kidney function in persons with type 2 diabetes and microalbuminuria #MMPMID28697799
  • Zobel EH; von Scholten BJ; Reinhard H; Persson F; Teerlink T; Hansen TW; Parving HH; Jacobsen PK; Rossing P
  • Cardiovasc Diabetol 2017[]; 16 (ä): ä PMID28697799show ga
  • Background: To evaluate symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA) as risk markers of cardiovascular disease, all-cause mortality and deterioration in renal function in a well characterised type 2 diabetic population with microalbuminuria and without symptoms of coronary artery disease. Methods: 200 participants followed for 6.1 years. SDMA and ADMA were measured at baseline. Endpoints included (1) composite cardiovascular endpoint (n = 40); (2) all-cause mortality (n = 26); and (3) decline in eGFR of >30% (n = 42). Cox models were unadjusted and adjusted for traditional risk factors (sex, age, systolic blood pressure, LDL-cholesterol, smoking, HbA1c, creatinine and urinary albumin excretion rate). To assess if SDMA or ADMA improved risk prediction beyond traditional risk factors we calculated c statistics and relative integrated discrimination improvement (rIDI). C statistic (area under the curve) quantifies the model?s improved ability to discriminate events from non-events. rIDI quantifies the increase in separation of events and non-events on a relative scale. Results: Higher SDMA was associated with increased risk of all three endpoints (unadjusted: p ? 0.001; adjusted: p ? 0.02). Higher ADMA was associated with all-cause mortality (unadjusted: p = 0.002; adjusted: p = 0.006), but not cardiovascular disease or decline in eGFR (p ? 0.29).The c statistic was not significant for any of the endpoints for either SDMA or ADMA (p ? 0.10). The rIDI for SDMA was 15.0% (p = 0.081) for the cardiovascular endpoint, 52.5% (p = 0.025) for all-cause mortality and 48.8% (p = 0.007) for decline in eGFR; for ADMA the rIDI was 49.1% (p = 0.017) for all-cause mortality. Conclusion: In persons with type 2 diabetes and microalbuminuria higher SDMA was associated with incident cardiovascular disease, all-cause mortality and deterioration in renal function. Higher ADMA was associated with all-cause mortality. SDMA and ADMA significantly improved risk prediction for all-cause mortality, and SDMA for deterioration in renal function beyond traditional risk factors. Electronic supplementary material: The online version of this article (doi:10.1186/s12933-017-0569-8) contains supplementary material, which is available to authorized users.
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