The article by Stühlinger et al1
in this issue of THE JOURNAL deserves to be read at least twice by physicians
involved in the care of patients with cardiovascular disease. Two readings
are needed not because the article is difficult to fathom, but because the
study demonstrates a potentially important relationship between insulin resistance
and plasma concentrations of the endogenous nitric oxide synthase (NOS) inhibitor
asymmetric dimethylarginine (ADMA). Elevated ADMA levels have been observed
in various conditions, including hypertension, dyslipidemia, hyperglycemia,
hyperhomocysteinemia, and renal failure, and are believed to be one cause
of endothelial dysfunction in these conditions.2
Elevated plasma ADMA concentrations are also associated with an increased
risk of cardiovascular disease.3
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