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March 20, 2002

Insulin Resistance, ADMA Levels, and Cardiovascular Disease

Author Affiliations

Author Affiliation: Syracuse Preventive Cardiology Center, Syracuse, NY.

JAMA. 2002;287(11):1451-1452. doi:10.1001/jama.287.11.1451

The article by Stühlinger et al1 in this issue of THE JOURNAL deserves to be read at least twice by physicians involved in the care of patients with cardiovascular disease. Two readings are needed not because the article is difficult to fathom, but because the study demonstrates a potentially important relationship between insulin resistance and plasma concentrations of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA). Elevated ADMA levels have been observed in various conditions, including hypertension, dyslipidemia, hyperglycemia, hyperhomocysteinemia, and renal failure, and are believed to be one cause of endothelial dysfunction in these conditions.2 Elevated plasma ADMA concentrations are also associated with an increased risk of cardiovascular disease.3