Changes in the system of asymmetric dimethylarginine - endothelial NO-synthase in patients with acute myocardial infarction and type 2 diabetes mellitus

The purpose of this study was the assessment of asymmetric dimethylarginine (ADMA) and its links with carbohydrate and lipid metabolism parameters in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus following determination of asymmetric dimethylarginine and NO synthase plasma levels. Materials and methods. The study included examination of 73 patients with acute myocardial infarction and type 2 diabetes mellitus, 57 patients with AMI without type 2 diabetes and 20 conditionally healthy individuals. The content of ADMA and NO synthase was measured by using an enzyme-linked immunosorbent assay kit (ADMA Xpress ELISA kit;Immundiagnostik,Austria) and Bender MedSystem (Austria), respectively. The parameters of carbohydrate and lipid metabolism were determined by a standard biochemical method. Results. A significant 2.64 times increased level of ADMA (1.24 ± 0.04 μmol/L) was found in the patients with AMI and type 2 diabetes compared to the practically healthy persons (control group) (0.47 ± 0.05 μmol/L), and 2.53 times increased (P < 0.05) in comparison with the patients without type 2 diabetes. In the presence of type 2 diabetes the 40.1 % (P < 0.05) decrease in NOs level was noted compared to the control group (3.12 ± 0.11ng / ml and 5.21 ± 0.19 ng/ml, respectively) and the 26.1 % (P < 0.05) decrease compared to the patients with AMI without type 2 diabetes. The study provided a possibility to determine a direct correlation between ADMA and total cholesterol (r = 0.47; P < 0.05); LDL cholesterol (r = 0.28; P < 0.05), HDL cholesterol (r = -0.39; P < 0.05), triglycerides (P = 0.35; P < 0.05), glucose (P = 0.46; P < 0.05), insulin = 0.49; P < 0.05), glycosylated hemoglobin (r = 0.39; P < 0.05). Correlation analysis showed an inverse correlation between ADMA and NO synthase levels (r = -0.67; P < 0.05). Conclusions. The association between asymmetric dimethylarginine high levels and pathological changes in the parameters of carbohydrate, lipid metabolism and endothelial dysfunction has been established, which increases ischemia in the vessel wall and adversely affects the course and prognosis of acute myocardial infarction in patients with type 2 diabetes mellitus.