Affiliations: Department of Cardiology, Leiden University Medical
Center, Leiden, The Netherlands | Department of Clinical Epidemiology, Leiden University
Medical Center, Leiden, The Netherlands | Einthoven Laboratory for Experimental Vascular
Medicine, Leiden University Medical Center, Leiden, The Netherlands | Department of Medical Statistics, Leiden University
Medical Center, Leiden, The Netherlands
Note: [] Corresponding author: Prof. Dr. J. Wouter Jukema, Department of
Cardiology C5-P, Leiden University Medical Center, PO Box 9600, 2300 RC,
Leiden, The Netherlands. Tel.: +31 715266695; Fax: +31 715266885; E-mail:
j.w.jukema@lumc.nl
Abstract: High Asymmetric Dimethylarginine (ADMA) levels are associated with
increased platelet activity, elevated blood pressure, vasoconstriction and
impaired vascular relaxation. We hypothesized that the myocardial infarction
morning peak of occurrence is closely related to a morning peak of ADMA levels.
We performed a cross-sectional study among patients with documented myocardial
infarction who had been enrolled in the prospective MISSION! Intervention
Study. In total, serum ADMA levels were measured in their acute setting of
myocardial infarction in 120 patients. The frequency of myocardial infarction
onset of symptoms and emergency coronary catheterization and the ADMA levels
displayed a similar daily pattern with a morning peak between 06:00–11:59 h.
The absolute ADMA levels peak was between 06:00–07:59 h with a median
(interquartile range) peak value of 1.01 (0.84–1.21) μmol/L for the n=9 patients vs. 0.75 (0.61–0.89)
μmol/L for the remaining 111 patients admitted throughout
the rest of the 24-hour interval (p=0.003 for between
groups comparison). The amplitude (95% 0.08 μmol/L
(0.004–0.16) with p=0.042 for statistic model
significance. In conclusion, ADMA levels display a 24-hour variation with a
significant morning peak in patients with acute myocardial infarction. These
findings may relate ADMA levels to the acute onset of thrombotic cardiovascular events.
