Distribution of asymmetric dimethylarginine in elderly population and its relationship with traditional cardiovascular risk factors

Öz

Objectives: The endogenous nitric oxide synthesis inhib-itor asymmetric dimethylarginine (ADMA) has emerged as a new cardiovascular risk factor, especially in recent years. We conducted this study to evaluate the ADMA plasma concentration distributions and the relationship of ADMA with other cardiovascular risk factors, pulse wave velocity (NDH) and augmentation index (Alx) in elderly individuals. Methods: This study was carried out as a part of the pro-ject called “health screening for the elderly” in Ankara Mamak district. All the elderly people in the region were invited for health screening with the calls made by the municipality and the headmen. Those who were severely debilitated, such as those with previously known ad-vanced stage organ failure, and whose laboratory tests could not perform were excluded from the study. While 966 people were evaluated in the total, 234 participants were excluded in the analysis. Participants' anamnesis were taken and detailed physical examinations were per-formed. Serum ADMA measurements were made by a single person using the Elisa method. SphygmoCor® Pulse Wave Velocity System device was used for NDH and Alx measurement. NDH measurements were evaluat-ed by a computer program on the same instrument, and results were obtained in m/s ± standard deviation. Results: The median age of the 966 participants was 70.3±6.4, and %49.6 of the participants were women. We found the mean ADMA level 0.85±0.38 µmol/L. In the correlation analysis evaluation, there was no correlation between ADMA and age, blood pressure, body mass in-dex, LDL cholesterol, HDL cholesterol, triglyceride, creatine, GFR and CRP levels. While there was a signifi-cant positive correlation between ALT levels (rho:0.106, p:0.001) and total cholesterol levels (rho:0.064, p:0.047) with ADMA, there was a negative correlation between fasting blood glucose (rho:-0.072, p:0.026) and ADMA, but all of these relationships were very weak. NDH and Alx were not significantly associated with ADMA con-centrations. In multiple regression analysis, only 1/3 of ADMA levels can be explained when an appropriate model is created with LDL, HDL, triglyceride, total cho-lesterol, ALT, and creatine. Conclusion: The ADMA mean of the participants in our population was 0.85±0.38 µmol/l. The relationship be-tween ADMA levels and known cardiovascular risk fac-tors is low. Cohort studies are needed to reveal the rela-tionship between ADMA levels and cardiovascular dis-eases.

Anahtar Kelimeler

• ADMA
• cardiovascular risk factors
• atherosclerosis
• arte-rial stiffness

Yaşlı popülasyonda asimetrik dimetilarjinin dağılımı ve geleneksel kardiyovasküler risk faktörleri ile arasındaki ilişki

Öz

Amaç: Endojen nitrik oksit sentez inhibitörü asimetrik dimetilarjinin (ADMA) özellikle son yıllarda yeni bir kardiyovasküler risk faktörü olarak ortaya çıkmaktadır. Biz bu çalışmayı AD-MA plazma konsantrasyon dağılımlarını, AD-MA’nın diğer kardiyovasküler risk faktörleriyle, nabız dalga hızı (NDH) ve augmentasyon indek-siyle (Alx) ilişkisini değerlendirmek için yaptık. Yöntem: Bu çalışma, Ankara Mamak ilçesinde “yaşlılarda sağlık taraması” ismiyle yürütülen projenin bir parçası olarak gerçekleştirildi. Beledi-ye ve muhtarların yaptığı çağrılarla bölgedeki tüm yaşlılar sağlık taraması için davet edildiler. Daha önceden bilinen ileri evre organ yetmezliği olanlar gibi ileri derecede düşkün olanlar ve laboratuvar tetkiklerini yaptıramayanlar çalışmaya alınmadı-lar. Toplamda 966 kişi değerlendirmeye alınırken, 234 katılımcı kriterleri karşılamaması nedeni ile analize alınmadı. Katılımcılar öyküleri alındı ve ayrıntılı fizik muayeneleri yapıldı. Serum ADMA ölçümleri ELISA yöntemi kullanılarak tek bir kişi tarafından yapıldı. NDH ve Alx ölçümünde SphygmoCor® Pulse Wave Velocity System cihazı kullanıldı. NDH ölçümleri aynı cihazdaki bir bilgisayar programı tarafından değerlendirildi ve sonuçlar m/sn ± standart sapma şeklinde elde edildi. Bulgular: Çalışmaya alınan 966 katılımcının ortanca yaşı 70.3±6.4 olup, katılımcıların %49.6'sı kadındı. Tüm popülasyonun ADMA ortalamasını 0.85±0.38 µmol/L olarak bulduk. Yapılan kore-lasyon analizi değerlendirmesinde, ADMA ile yaş, kan basıncı, vücut kitle indeksi, LDL kolesterol, HDL kolesterol, trigliserit, kreatin, GFR, CRP düzeyleri arasında korelasyon yoktu. ALT düzey-leri (rho:0.106, p:0.001) ve total kolesterol düzey-leri (rho:0.064, p:0.047) ile ADMA düzeyleri arasında anlamlı pozitif korelasyon var iken açlık kan şekeri (rho:-0.072, p:0.026) ile ADMA düzey-leri arasında anlamlı negatif korelasyon vardı ancak bu ilişkilerin tümü çok zayıf düzeydeydi. NDH ve Alx’in ADMA konsantrasyonları ile anlamlı ilişkisi yoktu. Çoklu regresyon analizinde LDL, HDL, trigliserit, total kolesterol, ALT, krea-tin ile uygun model oluşturulduğunda ADMA düzeylerinin ancak 1/3’lük kısmı açıklanabilmek-tedir. Sonuç: Popülasyonumuzdaki katılımcıların AD-MA ortalaması 0.85±0.38 µmol/l’dir. ADMA düzeylerinin bilinen kardiyovasküler risk faktör-leriyle ilişkisi düşük düzeydedir. ADMA düzeyle-rinin kardiyovasküler hastalıklar ile ilişkisini ortaya koyacak kohort çalışmalara ihtiyaç bulun-maktadır.

Anahtar Kelimeler

• ADMA
• kardiyovasküler risk faktörleri
• ateroskle-roz
• arteryel sertlik

Kaynakça

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