Asymmetric dimethylarginine is a marker of poor prognosis and coronary calcium in systemic lupus erythematosus

Objective. To determine the association of serum asymmetric dimethylarginine (ADMA) with clinical features, laboratory tests, treatment, cardiovascular risk factors, and subclinical atherosclerosis in patients with systemic lupus erythematosus (SLE). Methods. Serum ADMA concentrations were determined by ELISA, using purified ADMA as a standard. Coronary calcium was measured by helical computerized tomography. Results. Two hundred patients with SLE participated. Patients had a mean age of 44.3 ± 11.4 years and were 92% female, 61% Caucasian, 34% African American, 2% Asian, and 2% Hispanic; 18% had elevated ADMA levels. The mean ADMA was 0.31. Significantly higher ADMA levels were found in African Americans (p < 0.001), and were correlated with anti-dsDNA (p < 0.001), anti-Sm (p = 0.005), anti-ribonucleoprotein (p = 0.002), low C4 (p = 0.004), and high erythrocyte sedimentation rate (p < 0.001). ADMA was negatively associated with total cholesterol (p = 0.004). Elevated ADMA was associated with the presence of coronary calcium (p = 0.02). Conclusion. Elevated ADMA is strongly associated with African American ethnicity, anti-dsDNA, low complement, and prednisone use, all markers of poor prognosis in SLE. It is negatively associated with hyperlipidemia, but positively associated with coronary calcium. Thus, it identifies a subset of SLE patients with normal lipid levels who are at risk for atherosclerosis.