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Test ID: ADMA Asymmetric Dimethylarginine, Plasma

Reporting Name

Asymmetric Dimethyl Arginine, P

Useful For

Assessing the likelihood of future coronary events, in patients with coronary heart disease, type II diabetes mellitus, or kidney disease

 

Prompting intervention and assessing improvements among subjects with elevated ADMA and hypercholesterolemia or type II diabetes mellitus

Specimen Type

Plasma EDTA


Specimen Required


Patient Preparation: Fasting-overnight (12 hours)

Collection Container/Tube: Lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma EDTA Frozen (preferred)
  Ambient  7 days

Reference Values

<18 years: not established

≥18 years: 63-137 ng/mL

Day(s) and Time(s) Performed

Thursday; 11 a.m.

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

82542

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ADMA Asymmetric Dimethyl Arginine, P 80981-4

 

Result ID Test Result Name Result LOINC Value
83651 Asymmetric Dimethyl Arginine, P 80981-4
32053 ADMA Interpretation 69047-9

Clinical Information

Asymmetric dimethylarginine (ADMA) is an independent risk factor for major adverse cardiovascular events.(1-7) ADMA inhibits nitric oxide (NO) synthesis and is elevated in diseases related to endothelial dysfunction including hypertension, hyperlipidemia, and type II diabetes mellitus. Elevation in ADMA and subsequent NO synthesis inhibition leads to vasoconstriction, reduced peripheral blood flow, and reduced cardiac output.

 

Elevated plasma ADMA confers a 4- to 6-fold increased risk of subsequent cardiovascular events or mortality among patients with acute coronary syndrome,(3) unstable angina,(4) type II diabetes mellitus,(5) end-stage renal disease,(6) coronary heart disease,(7) and peripheral artery disease.(1) Baseline ADMA remained a significant risk factor of adverse events even after adjusting for low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, creatinine, and high-sensitivity C-reactive protein.

 

Plasma ADMA concentrations are lowered by rosuvastatin and atorvastatin, but not simvastatin in patients with hypercholesterolemia.(8) Addition of vildagliptin (Galvus) to metformin significantly reduced ADMA concentrations among patients with type II diabetes mellitus.(9)

Interpretation

In patients with preexisting coronary conditions or at high risk for coronary events (diabetes, renal insufficiency), asymmetric dimethylarginine (ADMA) levels in the upper tertile, above 112 ng/mL, confer an increased risk for future coronary events.

Clinical Reference

1. Chu R, Yu D, Chu J, et al: Prognostic efficacy of circulating asymmetric dimtheylarginine in patients with peripheral arterial disease: A meta-analysis of prospective cohort studies. Vascular 2018;26:322-330

2. Schulze F, Lenzen H, Hanefeld C, et al.: Asymmetric dimethylarginine is an independent risk factor for coronary heart disease: results from the multicenter Coronary Artery Risk Determination investigating the Influence of ADMA Concentration (CARDIAC) study. Am Heart J 2006 Sep;152(3):493.e1-8

3. Cavusoglu E, Ruwende C, Chopra V, et al: Relationship of baseline plasma ADMA levels to cardiovascular outcomes at 2 years in men with acute coronary syndrome referred for coronary angiography. Coron Artery Dis 2009;20:112-117

4. Krempl TK, Maas R, Sydow K, et al: Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events. Eur Heart J 2005;26:1846-1851

5. Cavusoglu E, Ruwende C, Chopra V, et al: Relation of baseline plasma ADMA levels to cardiovascular morbidity and mortality at two years in men with diabetes mellitus referred for coronary angiography. Atherosclerosis. 2010 May;210(1):226-231

6. Abedini S, Meinitzer A, Holme I, et al: Asymmetrical dimethylarginine is associated with renal and cardiovascular outcomes and all-cause mortality in renal transplant recipients. Kidney Int 2010 Jan;77(1):44-50

7. Valkonen VP, Paiva H, Salonen JT, et al: Risk of acute coronary events and serum concentration of asymmetrical dimethylarginine. Lancet 2001;358:2127-2128

8. Kurtoglu E, Sevket B, Sincer I, et al: Comparison of effects of Rosuvastatin versus Atorvastatin treatment on plasma levels of asymmetric dimethylarginine in patients with hyperlipidemia having coronary artery disease. Angiology 2014; 65:788-793

9. Cakirca M, Karatoprak C, Zorlu M, et al: Effect of vildagliptin add-on treatment to metformin on plasma asymmetric dimethylarginine in type 2 diabetes mellitus patients. Drug Des Devel Ther 2014;8:239-243

10. Ravani P, Tripepi G, Malberti F, et al: Asymmetrical dimethylarginine predicts progression to dialysis and death in patients with chronic kidney disease: a competing risks modeling approach. J Am Soc Nephrol 2005;16:2449-2455

Analytic Time

2 days

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Forms

If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.

Mayo Clinic Laboratories | Cardiology Catalog Additional Information:

mml-inflammation