Objective:

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To examine the prognostic value of serum levels of asymmetric dimethylarginine (ADMA) in patients with stable coronary heart disease (CHD) thus explore a potential biomarker of "toxin syndrome" in CHD.

Methods:

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In this prospective nested case-control study

36 of 1

503 Chinese patients with stable CHD experienced at least 1 recurrent cardiovascular event (RCE) during 1-year follow-up. Serum levels of ADMA at the start of follow-up were compared between these 36 cases and 36 controls which matched to cases in terms of gender

age

history of hypertension

and myocardial infarction.

Results:

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Based on the crude model

subjects in the 2 highest ADMA quartiles showed significantly higher risk of developing RCE than those in the lowest ADMA quartile [odds ratio (OR) 4.09

95% confidence interval (CI) 1.01 to 16.58; OR 6.76

95% CI 1.57 to 29.07]. This association was also observed in the case-mix model (OR 5.51

95% CI 1.23 to 24.61; OR 7.83

95% CI 1.68 to 36.41) and multivariable model (OR 6.64

95% CI 1.40 to 31.49; OR 13.14

95% CI 2.28 to 75.71) after adjusting for confounders. The multivariable model which combined ADMA and high-sensitivity C-reactive protein (hsCRP) showed better predictive power with areas under the receiver operator characteristic curves (0.779) than the model of either ADMA (0.694) or hsCRP (0.636).

Conclusion:

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Serum ADMA level may be a potential biomarker of "toxin syndrome" in CHD which shows favorable prognostic value in predicting 1-year RCE in patients with stable CHD. [The registration number is ChiCTR-PRNRC-07000012]