Natural enzyme linked to heart risk in diabetics
By Will Boggs, MD
NEW YORK (Reuters Health) - High blood levels of a naturally occurring enzyme linked to blood vessel function predict heart-related events and an increased risk of progressive kidney disease in patients with type 1 diabetes and kidney disease, according to new research.
The enzyme called ADMA, or asymmetrical dimethylarginine, inhibits a compound involved in blood vessel dilation. Previous research has shown that elevated blood levels of ADMA reduce the ability of the blood vessels to widen, and are also linked to an increased risk of heart and blood vessel disease.
Dr. Lise Tarnow from Steno Diabetes Center, Gentofte, Denmark and colleagues investigated the value of ADMA in predicting heart and kidney events in 397 type 1 diabetic patients with diabetic kidney disease and 175 diabetic controls without kidney disease.
Among the type 1 diabetics with kidney disease, significantly more patients with ADMA levels above the median (43.4 percent) than similar patients with ADMA levels below the median (19.4 percent) suffered a fatal or nonfatal major cardiovascular event, such as a heart attack, the investigators found.
They also found that patients with ADMA levels above the median experienced a faster decline in kidney function than patients with lower ADMA levels. Patients with higher ADMA levels were 3.2 times as likely as patients with lower ADMA levels to develop end-stage renal disease, the most advanced form of kidney disease.
Overall mortality was 67 percent higher among patients with higher ADMA levels than among patients with lower ADMA levels, Tarnow and colleagues also report.
If confirmed in other studies, ADMA, or might help doctors identify type 1 diabetic patients at particularly high risk of adverse heart and kidney-related events.
SOURCE: Diabetes Care, April 2008.