Assessing the Role of Asymmetric Dimethylarginine in Endothelial Dysfunction: Insights Into Cardiovascular Risk Factors

Asymmetric dimethylarginine (ADMA) exacerbates endothelial dysfunction, which increases the risk of kidney and cardiovascular problems. This study aimed to investigate the association of ADMA levels in patients with type 2 diabetes mellitus (T2DM), including diabetic heart disease and diabetic kidney disease (DKD).

This was a cross-sectional study conducted in a tertiary hospital, including 136 participants, categorizing them into four groups aged between 18-65 years: normal healthy controls (n=30), diabetes mellitus (DM) group with T2DM patients (n=39), diabetics with coronary artery disease (DCAD) group with T2DM patients with coronary artery disease (CAD) (n=34), and DKD group with T2DM patients with deranged kidney function (n=33). Comprehensive clinical and laboratory assessments were conducted, including ADMA levels quantified via enzyme-linked immunosorbent assay (ELISA) kits.  Results: In the study with 136 participants, 91 were male (66.9%), and averaging 55 years old, hypertension was prevalent in 34 participants (32.1%), more in the DKD group. Exercise adherence was low, especially among diabetic patients, but slightly better in those with complications. Among diabetics, 71 participants (67%) had uncontrolled blood sugar (glycosylated hemoglobin (HbA1c) > 7.0). Dyslipidemia was common in the DCAD group. The DKD group showed significantly low hemoglobin and proteinuria levels. The ADMA levels were significantly raised in diabetes and were maximum in the DCAD group, hence promising for predicting CAD, correlating with HbA1c and dyslipidemia.

In summary, our findings underscore the heightened cardiovascular vulnerability in diabetes, particularly in the presence of CAD and deranged kidney function. Endothelial dysfunction emerges as a critical factor, emphasizing the importance of monitoring ADMA levels, which can independently predict worse cardiovascular outcomes. Managing hyperglycemia, hypertension, and dyslipidemia is pivotal for reducing cardiovascular risks in diabetic patients. Further exploration of preventive strategies is warranted.