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HelpTest Code ADMA Asymmetric Dimethylarginine, Plasma
Reporting Name
Asymmetric dimethylarginine, PUseful For
Assessing the likelihood of future coronary events in patients with coronary heart disease, type II diabetes mellitus, or kidney disease
Prompting intervention and assessing improvements among subjects with elevated ADMA and hypercholesterolemia or type II diabetes mellitus
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Plasma EDTASpecimen Required
Patient Preparation: Fasting-overnight (12 hours)
Collection Container/Tube: Lavender top (EDTA)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge and aliquot 1 mL of plasma into plastic vial.
2. Send specimen frozen.
Specimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma EDTA | Frozen (preferred) | 90 days | |
| Ambient | 7 days | ||
| Refrigerated | 7 days |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Reference Values
≥18 years: 63-137 ng/mL
Reference values have not been established for patients who are <18 years of age
Day(s) Performed
Thursday
CPT Code Information
82542
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ADMA | Asymmetric dimethylarginine, P | 80981-4 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 83651 | Asymmetric dimethylarginine, P | 80981-4 |
Clinical Information
Asymmetric dimethylarginine (ADMA) is an independent risk factor for major adverse cardiovascular events.(1-7) ADMA inhibits nitric oxide (NO) synthesis and is elevated in diseases related to endothelial dysfunction including hypertension, hyperlipidemia, and type II diabetes mellitus. Elevation in ADMA and subsequent NO synthesis inhibition leads to vasoconstriction, reduced peripheral blood flow, and reduced cardiac output.
Elevated plasma ADMA confers a 4- to 6-fold increased risk of subsequent cardiovascular events or mortality among patients with acute coronary syndrome,(3) unstable angina,(4) type II diabetes mellitus,(5) end-stage renal disease,(6) coronary heart disease,(7) and peripheral artery disease.(1) Baseline ADMA remained a significant risk factor of adverse events even after adjusting for low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, creatinine, and high-sensitivity C-reactive protein.
Plasma ADMA concentrations are lowered by rosuvastatin and atorvastatin, but not simvastatin in patients with hypercholesterolemia.(8) Addition of vildagliptin (Galvus) to metformin significantly reduced ADMA concentrations among patients with type II diabetes mellitus.(9)
Interpretation
In patients with preexisting coronary conditions or at high risk for coronary events (diabetes, renal insufficiency), asymmetric dimethylarginine levels in the upper tertile, above 112 ng/mL, confer an increased risk for future coronary events.
Cautions
No significant cautionary statements
Method Description
Asymmetric dimethylarginine is separated and quantified by liquid chromatography-tandem mass spectrometry.(Unpublished Mayo method)