Asymmetric dimethylarginine as a risk marker for early-onset ischemic stroke in Indian population

Background: Asymmetric dimethylarginine (ADMA), a circulating endogenous inhibitor of nitric oxide synthase, has been associated with the pathogenesis of atherosclerosis. The present study was initiated to investigate the role of ADMA as a biomarker of risk for early-onset ischemic stroke. Methods: Plasma ADMA levels were measured in 201 ischemic stroke patients aged between 15 and 50 years and 217, age and gender-matched healthy controls, by high performance liquid chromatography using pre-column derivatization with O-phthaldialdehyde. Results: Patients with ischemic stroke had significantly higher plasma ADMA compared with the controls (1.49 vs. 0.97 mu mol/l, p<0.001). After adjustment for vascular risk factors, increased ADMA was associated with stroke (OR = 1.55, 95% CI 1.25-1.92, p<0.001). Univariate analysis showed that ADMA was significantly associated with age, alcohol, smoking, hypertension, diabetes mellitus, low serum HDL-cholesterol and homocysteine. By multiple stepwise linear regression analysis, diabetes, HDL-cholesterol and homocysteine were found to be independent determinants of plasma ADMA. Conclusions: Increased plasma ADMA is associated with increased risk for ischemic stroke in the young. Diabetes mellitus, HDL-cholesterol and homocysteine are independent predictors of elevation in plasma ADMA concentration. (C) 2010 Elsevier B.V. All rights reserved.