Association of Homocysteine and Asymmetric Dimethylarginine With Atherosclerosis and Cardiovascular Events in Maintenance Hemodialysis Patients
- 30 November 2006
- journal article
- Published by Elsevier BV in American Journal of Kidney Diseases
- Vol. 48 (5), 797-805
- https://doi.org/10.1053/j.ajkd.2006.08.003
Abstract
Background: Homocysteine (Hcy) and asymmetric dimethylarginine (ADMA) recently were recognized as potential risk factors for atherosclerosis in the general population, and the metabolism of each of these substances seems to be closely related. This study investigates the association between these substances and whether elevated serum Hcy and ADMA levels are related to high risk for atherosclerosis and cardiovascular events in maintenance hemodialysis (HD) patients. Methods: A study was made of 197 HD patients (132 men, 65 women; mean age, 56.9 ± 8.6 years) for the correlation between plasma total Hcy (tHcy) and ADMA concentrations and the association of these substances with atherosclerotic indices of cervical intima-media thickness, plaque diameter, aortic calcification index, and aortic elongation. Cardiovascular events were followed up for 5 years in these patients. Results: Mean plasma tHcy (37.3 ± 25.8 μmol/L) and ADMA (0.77 ± 0.16 μmol/L) levels were significantly greater in HD patients than in healthy subjects. Plasma tHcy level did not correlate with plasma ADMA level (r = −0.1; P = not significant). Although ADMA level was associated significantly with atherosclerotic indices from a simple regression analysis, this association was less from multiple regression analysis. When patients were classified into 3 groups according to ADMA level, cardiovascular events during 5 years were significantly greater in the group with the highest ADMA levels than in the other groups, confirmed by using a Cox proportional hazard model. However, no association was found between tHcy levels and atherosclerotic indices or cardiovascular events. Conclusion: ADMA level emerged as a potential risk factor for cardiovascular events that might be mediated in part by atherosclerosis in HD patients. Conversely, neither high nor low plasma tHcy levels were associated with atherosclerotic indices and cardiovascular events. This result for our HD patients does not fulfill the terms of traditional epidemiology and paradoxical reverse epidemiology of Hcy.Keywords
This publication has 24 references indexed in Scilit:
- Homocysteine in uraemia--a puzzling and conflicting storyNephrology Dialysis Transplantation, 2004
- Randomized Trial of Folic Acid for Prevention of Cardiovascular Events in End-Stage Renal DiseaseJournal of the American Society of Nephrology, 2004
- A Low, Rather than a High, Total Plasma Homocysteine Is an Indicator of Poor Outcome in Hemodialysis PatientsJournal of the American Society of Nephrology, 2004
- Homocysteine and Risk of Ischemic Heart Disease and StrokeJAMA, 2002
- Hyperhomocysteinemia predicts cardiovascular outcomes in hemodialysis patientsKidney International, 2002
- Hyperhomocysteinemia, nutritional status, and cardiovascular disease in hemodialysis patientsKidney International, 2000
- Plasma Total Homocysteine and Hemodialysis Access ThrombosisJournal of the American Society of Nephrology, 1999
- Prospective Study of Hyperhomocysteinemia as an Adverse Cardiovascular Risk Factor in End-Stage Renal DiseaseCirculation, 1998
- Plasma Homocysteine Levels and Mortality in Patients with Coronary Artery DiseaseNew England Journal of Medicine, 1997
- Hyperhomocysteinemia: An Independent Risk Factor for Vascular DiseaseNew England Journal of Medicine, 1991