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HelpTest ID: ADMA Asymmetric Dimethylarginine, Plasma
Reporting Name
Asymmetric dimethylarginine, PUseful 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
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 levels in the upper tertile, above 112 ng/mL, confer an increased risk for future coronary events.
Report Available
2 to 9 daysDay(s) Performed
Thursday
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;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;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;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
11. Elesber AA, Solomon H, Lennon RJ, et al. Coronary endothelial dysfunction is associated with erectile dysfunction and elevated asymmetric dimethylarginine in patients with early atherosclerosis. Eur Heart J. 2006;27(7):824-31
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Specimen Type
Plasma EDTASpecimen Required
Patient Preparation: Fasting-overnight (12 hours)
Collection Container/Tube: Lavender top (EDTA)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge and aliquot 1 mL of plasma into plastic vial.
2. Send specimen frozen.
Specimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma EDTA | Frozen (preferred) | 90 days | |
| Ambient | 7 days | ||
| Refrigerated | 7 days |
Reference Values
≥18 years: 63-137 ng/mL
Reference values have not been established for patients who are <18 years of age
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82542
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ADMA | Asymmetric dimethylarginine, P | 80981-4 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 83651 | Asymmetric dimethylarginine, P | 80981-4 |
Forms
If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.
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