ADMA/SDMA may be measured in individuals with multiple risk factors for the development of CVD.
One of the earliest manifestations of endothelial dysfunction is nitric oxide (NO) deficiency, which promotes atherosclerosis. Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), its structural isomer, are metabolites of L-arginine, an amino acid that is catalyzed to L-citrulline and NO by nitric oxide synthase (NOS).
Both ADMA and SDMA have distinct pathophysiologies and manifestations. ADMA is a competitive inhibitor of NOS thereby reducing NO production and promoting endothelial dysfunction. SDMA also interferes with NO production, but does so indirectly by reducing the cellular availability of arginine. ADMA is primarily cleared through enzymatic degradation in the bloodstream and its presence identifies subclinical cardiovascular disease (CVD). Conversely, SDMA is primarily excreted in the urine and identifies reduced renal function.
Interpretation:
ADMA: Low // SDMA: Low
Normal endothelial function Med High Low
ADMA: Med / High // SDMA: Low
Endothelial dysfunction and possible presence of pre-diabetes/diabetes or CVD
ADMA: Low // SDMA: High
Reduced renal function
ADMA: Med / High // SDMA: High
- Endothelial dysfunction and possible presence of pre-diabetes/diabetes or CVD
- Reduced renal function
References:
American Diabetes Association Professional Practice Committee; 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S125–S143. https://doi.org/10.2337/dc22-S009
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Elevated levels of ADMA may identify:
- Endothelial dysfunction
- Pre-diabetes/diabetes
- Subclinical cardiovascular disease
Higher levels of ADMA are associated with a 1.40x increased risk of CVD and coronary heart disease, as well as a 1.60x increased risk of stroke, in a general population.
-- Elevated ADMA levels are associated with the presence of hypertension, insulin resistance, and hyperlipidemia.
-- Elevated ADMA levels are associated with subclinical atherosclerosis:
-- Individuals with established coronary artery disease and elevated ADMA levels have more than twice the risk for adverse events (myocardial infarction, stroke) than those with normal ADMA levels.
Treatment Considerations:
These treatment considerations are for educational purposes only. Specific treatment plans should be provided and reviewed by the treating practitioner.
Assess lifestyle habits.
- Consider diet, exercise, and weight reduction efforts, if appropriate.
Assess LDL-C levels.
- If not at an optimal level, consider lipid-lowering therapies described in the National Cholesterol Education Program/Adult Treatment Panel III (NCEP ATP III) Guidelines. [L]
Assess insulin sensitivity.
- If not at an optimal level, consider insulin-sensitizing therapies described in the American Diabetes Association guidelines for the management of pre-diabetes/ diabetes. [L]
Assess blood pressure.
- If not at an optimal level, consider initiating, or titrating, antihypertensive therapy.
- Consider L-arginine or L-citrulline supplementation to enhance NO production, and to improve vasodilation and vascular tone.
Assess the presence of coronary artery disease (CAD) with imaging techniques, such as carotid intima-media thickness (CIMT) testing or coronary artery calcium (CAC) scoring.
Assess clotting risk.
- Consider antiplatelet therapy if history of CAD (i.e., myocardial infarction or revascularization) and/or cerebrovascular disease (i.e., transient ischemic attack or stroke).
Assess renal function.
- If SDMA levels are not optimal, consider further assessment and treatment considerations for kidney disease, as outlined in the National Kidney Foundation guidelines. [L]
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Anthony
Unlimited Plan Member since 2021
I have been using Healthmatters.io since 2021. I travel all over the world and use different doctors and health facilities. This site has allowed me to consolidate all my various test results over 14 years in one place. And every doctor that I show this to has been impressed. Because with any health professional I talk to, I can pull up historical results in seconds. It is invaluable. Even going back to the same doctor, they usually do not have the historical results from their facility in a graph format. That has been very helpful.
Karin
Advanced Plan Member since 2020
What fantastic service and great, easy-to-follow layouts! I love your website; it makes it so helpful to see patterns in my health data. It's truly a pleasure to use. I only wish the NHS was as organized and quick as Healthmatters.io. You've set a new standard for health tracking!
Paul
Healthmatters Pro Member since 2024
As a PRO member and medical practitioner, Healthmatters.io has been an invaluable tool for tracking my clients' data. The layout is intuitive, making it easy to monitor trends and spot patterns over time. The ability to customize reports and charts helps me present information clearly to my clients, improving communication and outcomes. It's streamlined my workflow, saving me time and providing insights at a glance. Highly recommended for any practitioner looking for a comprehensive and user-friendly solution to track patient labs!
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