Department of Cardiology, Ningbo Fourth Hospital, Ningbo, 315700, Zhejiang, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Disease, ZhongShan Hospital, Fudan University, 200032, Shanghai, China.
Nitric Oxide. 2021 May 1;109-110:50-56. doi: 10.1016/j.niox.2021.03.002. Epub 2021 Mar 6.
Studies regarding the predictive utility of the blood level of asymmetric dimethylarginine (ADMA) in patients with coronary artery disease (CAD) have yielded the conflicting findings. This meta-analysis sought to evaluate the prognostic value of blood ADMA level in CAD patients.
Potentially relevant studies were identified by searching PubMed and Embase database until August 12, 2020. Cohort studies evaluating the association of blood ADMA level with all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) were included. A random effect model was applied to pool the multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) for the highest versus lowest ADMA level.
Data were retrieved from 11 studies enrolling a total of 9496 CAD patients. When compared the highest to the lowest ADMA level, the pooled RR was 2.10 (95% CI 1.46-3.02) for all-cause mortality, 2.49 (95% CI 1.34-4.65) for cardiovascular mortality, and 1.71 (95% CI 1.27-2.32) for MACEs, respectively. However, subgroup analysis showed that there were no significant association between elevated ADMA level and all-cause mortality in acute coronary syndrome (RR 2.11; 95% CI 0.93-4.78) and follow up ≤ 1 year (RR 2.15; 95% CI 0.56-8.25) subgroup.
Elevated blood ADMA level is possibly an independent predictor of all-cause mortality, cardiovascular mortality, and MACEs in CAD patients. Measurement of blood level of ADMA may improve risk classification of CAD. However, these findings should be interpreted with caution because of the limited number of studies included.
关于不对称二甲基精氨酸（ADMA）血水平在冠心病（CAD）患者中的预测效用的研究得出了相互矛盾的结果。本荟萃分析旨在评估 CAD 患者血液 ADMA 水平的预后价值。
通过搜索 PubMed 和 Embase 数据库，直到 2020 年 8 月 12 日，确定了潜在相关的研究。纳入评估血液 ADMA 水平与全因死亡率、心血管死亡率和主要不良心血管事件（MACE）之间相关性的队列研究。应用随机效应模型对最高与最低 ADMA 水平的多变量调整风险比（RR）和 95%置信区间（CI）进行汇总。
从 11 项共纳入 9496 例 CAD 患者的研究中提取数据。与最低 ADMA 水平相比，最高 ADMA 水平的全因死亡率、心血管死亡率和 MACE 的汇总 RR 分别为 2.10（95%CI 1.46-3.02）、2.49（95%CI 1.34-4.65）和 1.71（95%CI 1.27-2.32）。然而，亚组分析显示，在急性冠状动脉综合征（RR 2.11；95%CI 0.93-4.78）和随访时间≤1 年（RR 2.15；95%CI 0.56-8.25）亚组中，升高的 ADMA 水平与全因死亡率之间无显著相关性。
升高的血液 ADMA 水平可能是 CAD 患者全因死亡率、心血管死亡率和 MACE 的独立预测因子。血液 ADMA 水平的测量可能改善 CAD 的风险分类。然而，由于纳入的研究数量有限，这些发现应谨慎解释。
