Study Identifies Predictor of Poor Survival in AASV Patients
Patients with anti-neutrophil-cytoplasmic antibodies (ANCA)-associated small vessel vasculitis (AASV) are at increased risk of endothelial dysfunction, cardiovascular events (CVE), and accelerated atherosclerosis. A study of sera from 89 patients with AASV were assessed during active disease and remission to determine whether endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) and its stereoisomer symmetric dimethylarginine (SDMA) could serve as predictors of cardiovascular risk in these patients.
SMDA and ADMA levels were compared against clinical data on disease activity, remission, relapse rate, and 5-year follow-up for CVE and renal outcomes. Overall, the patient cohort had a low overall CVE rate of 8%, and SDMA and ADMA were not predictive of CVE at 5-year follow-up; however, SDMA levels were significantly associated with poorer survival (death/end-stage renal disease) independent of entry glomerular filtration rate. No such association was found for ADMA levels.
The authors concluded that “this novel finding in a well-defined group of AASV patients indicates a different mechanism of endothelial response in AASV,” suggesting further investigation in a larger cohort of AASV patients with a higher CVE rate and/or longer follow-up is warranted.
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Erdbrügger U, Kielstein JT, Westman K, et al. Higher levels of SDMA and not ADMA are associated with poorer survival of trial patients with systemic ANCA-associated vasculitis. European Journal of Rheumatology. 2018;5(3):153-159. doi:10.5152/eurjrheum.2018.17119.