Document Detail

Non-invasive assessment of coronary flow reserve and ADMA levels: a case-control study of early rheumatoid arthritis patients.
MedLine Citation:
PMID:  19465588     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Plasma concentration of asymmetric dimethylarginine (ADMA), a major endogenous inhibitor of nitric oxide synthase, is considered a novel risk factor for endothelial dysfunction associated with enhanced atherosclerosis. Coronary microcirculation abnormalities have been demonstrated in patients with early rheumatoid arthritis (ERA) without any signs or symptoms of coronary artery disease (CAD). The aim of the study was to compare the ERA and control groups with ADMA, intima-media thickness (IMT) and coronary flow reserve (CFR) levels. It assessed whether ERA patients have more cardiovascular risk (endothelial dysfunction and coronary microvascular abnormalities), and evaluated whether any difference in IMT/CFR between ERA and controls can be explained by any difference in ADMA levels between the groups. METHODS: The study involved 25 ERA patients (female/male 21/4; mean age 52.04 +/- 14.05 years; disease duration <or=12 months) and 25 healthy volunteers with no history or current signs of CAD or other traditional risk factors. Dipyridamole trans-thoracic stress echocardiography was preformed to evaluate CFR, and carotid ultrasound to measure the IMT of the common carotid arteries. Blood samples were obtained in order to assess ADMA levels before the patients had received any biological or non-biological DMARDs, or steroid therapy. RESULTS: CFR was significantly reduced in the ERA patients (2.5 +/- 0.5 vs 3.5 +/- 0.8; P <0.01). In particular, 6/25 (24%) had a CFR of <2 consistent with potentially dangerous coronary flow impairment. Common carotid IMT was significantly greater in the ERA patients, although still within the normal range (0.68 +/- 0.1 vs 0.56 +/- 0.11 mm; P <0.01). There was a significant correlation between CFR and plasma ADMA levels in the ERA population (r = -0.53; P <0.01). IMT was negatively associated with CFR (P <0.05). CONCLUSIONS: Plasma ADMA levels were significantly higher in the ERA patients. A statistically significant negative effect of ADMA levels on CFR value was observed. The effect of ADMA levels on IMT is not significant.
Maurizio Turiel; Fabiola Atzeni; Livio Tomasoni; Simona de Portu; Luigi Delfino; Bruno Dino Bodini; Matteo Longhi; Simona Sitia; Mauro Bianchi; Paolo Ferrario; Andrea Doria; Vito De Gennaro Colonna; Piercarlo Sarzi-Puttini
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Publication Detail:
Type:  Journal Article     Date:  2009-05-22
Journal Detail:
Title:  Rheumatology (Oxford, England)     Volume:  48     ISSN:  1462-0332     ISO Abbreviation:  Rheumatology (Oxford)     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-16     Completed Date:  2009-09-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883501     Medline TA:  Rheumatology (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  834-9     Citation Subset:  AIM; IM    
Department of Health Technologies, Cardiology Unit, IRCCS Orthopedic Galeazzi Institute, University of Milan, Milano, Italy.
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MeSH Terms
Arginine / analogs & derivatives*,  blood
Arthritis, Rheumatoid / blood,  physiopathology*
Biological Markers / blood
Carotid Artery, Common / ultrasonography
Case-Control Studies
Coronary Circulation / physiology*
Dipyridamole / diagnostic use
Echocardiography, Stress
Linear Models
Middle Aged
Nitric Oxide Synthase / antagonists & inhibitors
Regional Blood Flow
Tunica Media / ultrasonography
Vasodilator Agents / diagnostic use
Reg. No./Substance:
0/Biological Markers; 0/Vasodilator Agents; 30315-93-6/N,N-dimethylarginine; 58-32-2/Dipyridamole; 74-79-3/Arginine; EC Oxide Synthase

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