ADMA AS A PREDICTIVE BIOMARKER IN CORONARY HEART DISEASE WITH CON COMITANT MASLD: A PRACTICAL APPROACH

Abstract

Background: Endothelial dysfunction is a fundamental mechanism in the development of coronary heart disease (CHD). Asymmetric dimethylarginine (ADMA) has emerged as a promising non-invasive biomarker for assessing endothelial impairment. Given the growing incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) among CHD patients, evaluating the practical utility of ADMA measurement is of clinical significance.

Objective: To assess the clinical relevance of serum ADMA levels in patients with CHD and to determine its association with MASLD and related metabolic disturbances.

Materials and methods: A total of 85 patients with confirmed CHD were enrolled and divided into two groups: 42 patients with MASLD and 43 patients without MASLD. CHD was diagnosed based on clinical evaluation, electrocardiography, and coronary angiography, while MASLD was confirmed via liver ultrasound. Serum ADMA levels were measured using enzyme-linked immunosorbent assay (ELISA). Additional metabolic parameters, including body mass index (BMI), arterial hypertension, and type 2 diabetes mellitus, were recorded.

Results: Patients with MASLD exhibited significantly higher BMI values (32.8 ± 3.5 kg/m²) compared to those without MASLD (27.1 ± 2.9 kg/m², p<0.01). In the MASLD group, arterial hypertension was present in 80% of patients, and type 2 diabetes mellitus was observed in 52% of patients, whereas no patients in the non-MASLD group had AH or T2DM (p<0.05). Serum ADMA levels were markedly elevated in the MASLD group (165.9 ± 24.3 ng/mL) compared to the non-MASLD group (129.4 ± 20.2 ng/mL, p<0.001). Additionally, patients with three or more metabolic disturbances showed even higher ADMA concentrations.

Conclusion: The data support the practical utility of ADMA as a predictive biomarker for endothelial dysfunction in CHD patients, particularly those with concomitant MASLD and metabolic disorders. The incorporation of ADMA measurement into routine clinical practice could facilitate early risk stratification and guide personalized therapeutic strategies to reduce cardiovascular complications. Overall, these findings underscore the importance of integrating metabolic assessments into cardiovascular risk evaluation.