Borgeraas Heidi, Hertel Jens Kristoffer, Svingen Gard Frodahl Tveitevåg, Pedersen Eva Ringdal, Seifert Reinhard, Nygård Ottar, Hjelmesæth Jøran
Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.
Department of Endocrinology, Morbid Obesity and Preventive Medicine Institute of Clinical Medicine University of Oslo, Oslo, Norway.
PLoS One. 2016 Mar 22;11(3):e0152029. doi: 10.1371/journal.pone.0152029. eCollection 2016.
Asymmetric dimethylarginine (ADMA) is associated with increased risk of atherosclerotic cardiovascular disease and mortality through inhibition of nitrogen oxide (NO) synthesis. As positive correlations between serum concentrations of NO and body mass index (BMI) have been observed, we aimed to explore whether the potential associations between plasma ADMA levels and the risk of acute myocardial infarction (AMI) and mortality were modified by BMI.
Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HR) for AMI, cardiovascular death and all-cause mortality according to baseline plasma ADMA levels in 4122 patients with suspected stable angina pectoris. Analyses were subsequently repeated in patients with BMI below (low BMI) or above (high BMI) median.
A total of 2982 patients (72%) were men. Median (range) age, plasma ADMA level and BMI were 62 (21-88) years, 0.54 (0.10-1.25) μmol/L and 26.3 (18.5-54.3) kg/m2, respectively. During a mean (standard deviation) follow-up time of 4.7 (1.4) years, 337 (8%) patients suffered from an AMI, 300 (7%) died, whereof 165 (55%) due to cardiovascular disease. Each 0.1 μmol/L increment in plasma ADMA level was associated with an increased risk of AMI (HR (95% CI) 1.21 (1.08, 1.35) and cardiovascular death 1.30 (1.13, 1.49) in participants with low BMI only. Interactions were significant for AMI (p = 0.04) and CV death (p = 0.03). BMI did not modify the association between plasma ADMA levels and all-cause mortality.
Plasma ADMA levels were associated with risk of AMI and cardiovascular death among patients with low BMI only.
不对称二甲基精氨酸（ADMA）通过抑制一氧化氮（NO）合成，与动脉粥样硬化性心血管疾病风险增加及死亡率升高相关。由于已观察到血清NO浓度与体重指数（BMI）之间存在正相关，我们旨在探讨血浆ADMA水平与急性心肌梗死（AMI）风险及死亡率之间的潜在关联是否受BMI影响。
采用多变量Cox比例风险模型，根据4122例疑似稳定型心绞痛患者的基线血浆ADMA水平，估计AMI、心血管死亡和全因死亡率的风险比（HR）。随后在BMI低于（低BMI）或高于（高BMI）中位数的患者中重复进行分析。
共有2982例患者（72%）为男性。年龄中位数（范围）、血浆ADMA水平和BMI分别为62（21 - 88）岁、0.54（0.10 - 1.25）μmol/L和26.3（18.5 - 54.3）kg/m²。在平均（标准差）4.7（1.4）年的随访期内，337例（8%）患者发生AMI，300例（7%）死亡，其中165例（55%）死于心血管疾病。仅在低BMI参与者中，血浆ADMA水平每增加0.1μmol/L，与AMI风险增加相关（HR（95%CI）1.21（1.08，1.35））以及心血管死亡风险增加相关（1.30（1.13，1.49））。AMI（p = 0.04）和心血管死亡（p = 0.03）的交互作用显著。BMI未改变血浆ADMA水平与全因死亡率之间的关联。
仅在低BMI患者中，血浆ADMA水平与AMI风险及心血管死亡相关。
