Key result
Asymmetric DiMethyl Arginine (ADMA) plasma levels were significantly higher in young asymptomatic patients with cerebral small vessel disease compared to matched controls (70.44 vs 46.58 ng/ml, p=0.004).
Why the study?
Sporadic small vessel disease can represent a prelude to stroke and cognitive impairment in young asymptomatic subjects, but its pathogenesis remains unclear.
Are ADMA levels elevated in young asymptomatic patients with cerebral small vessel disease compared to healthy controls?
Case-Control (n=70)
No
Are ADMA levels elevated in young asymptomatic patients with cerebral small vessel disease compared to healthy controls?
Absolute Event Rate: 70.44% vs 46.58%
p-value: p=0.004
Higher ADMA levels in young asymptomatic patients with sporadic small vessel disease reinforce the hypothesis that endothelial dysfunction plays a key role in its pathogenesis.
Elevated ADMA may reflect endothelial dysfunction in early cerebral small vessel disease; leaves open its value for risk stratification or intervention.
Sporadic small vessel disease (SVD) has high prevalence in aging population and stroke patients, but also in younger asymptomatic subjects. In this last group it can represents a prelude to stroke and cognitive impairment. Still nowadays, its pathogenesis is unclear. 35 consecutive patients with SVD at brain MRI and 35 age- and sex-matched controls, between January 2016 and February 2018, underwent an extended screening for thrombophilia, autoimmunity and evaluated levels of blood markers of inflammation and endothelial activation. Asymmetric DiMethyl Arginine (ADMA) levels proved higher in patients (70.44 ± 36.25 ng/ml vs. 46.58 ± 30.67 ng/ml; p = 0.004), also after controlling for confounding factors. ADMA levels showed positive correlation with Fazekas score (r = 0.304; p = 0.01). ROC curve analysis showed a moderate accuracy in discriminating patients and controls (AUC = 0.70; CI 0.57-0.82; p = 0.004): a cut-off of 46 ng/ml is associated with 80% sensitivity, but limited (54%) specificity. Higher ADMA levels characterize selected subjects with sporadic SVD, asymptomatic for vascular diseases and without latent inflammatory conditions or coagulopathy. This reinforces the hypothesis of the key role of endothelial dysfunction in SVD. Further studies should explore the cause-effect relationship between ADMA pathway and SVD.
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Janes et al. (2019) conducted a case-control in Cerebral small vessel disease (n=70). Asymmetric DiMethyl Arginine (ADMA) levels vs. Healthy controls was evaluated on ADMA plasma levels (p=0.004). Asymmetric DiMethyl Arginine (ADMA) plasma levels were significantly higher in young asymptomatic patients with cerebral small vessel disease compared to matched controls (70.44 vs 46.58 ng/ml, p=0.004).
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