Abstract:
Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of Nitric oxide (NO)
production. It is synthesized by post translational modification of L-arginine which
involves the set of enzymes called protein arginine methyl transferases (PRMTs). It has
been identified as a hallmark of vascular endothelium destruction since it inhibits NO mediated vasodilation in the endothelial cells. Periodontal disease has been linked to
cardiovascular diseases (coronary artery disease) because of the shared risk factors and
etiology. However, the relevance of ADMA as a reliable measure of endothelial
dysfunction in individuals with cardiovascular disorders and periodontal disease, where
it has been discovered at elevated levels, remains unclear. ADMA might provide origin
for the interaction of cardiovascular diseases and periodontitis. Thus, this research
investigates serum ADMA as a measure of endothelial dysfunction in periodontal and
coronary heart disease patients. The objectives of this study was to evaluate the levels of
ADMA, inflammatory mediators, lipid profile, and periodontal parameters in individuals
with cardiovascular diseases and periodontitis, which may have significant implications
for understanding the interplay between these conditions. In this case control study, after
the attainment of FRC and ERC approval; 22 subjects with chronic periodontitis (CP), 22
subjects with coronary heart disease (CHD), 22 subjects with both periodontitis and
coronary heart disease (CHD) and 22 systemically healthy controls aged between 30-60
years were recruited. All the male and female individuals were selected on the basis of
inclusion criteria prior taking written informed consent. The clinical and periodontal
parameters (plaque index, probing pocket depth, clinical attachment level and bleeding
on probing) were assessed in the participants of the study. The overnight fasting blood
samples of patients were obtained for analysis of ADMA, C-reactive protein and lipid
profile. The results were analyzed with SPSS version 23.0. ADMA was significant in all
the groups (CP, CHD, CP+CHD and Controls). Subsequently the parameters of lipid
profile TC, HDL and LDL were significant among the groups. Inflammatory mediator
hs-CRP was also significant among all the groups. The periodontal clinical parameters
which includes number of teeth, PD, CAL, BoP% and PI were also significant among all
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the groups (p<0.05). The significant correlations were found for parameters which
includes studied groups, gender, hsCRP, HDL, no. of teeth, BoP and PI. Multivariate
regression analysis showed significant positive association for the case groups (CP, CHD
and CP+CHD) for ADMA. Our results specified that serum ADMA levels may be a
valuable measure of endothelial dysfunction in individuals with periodontal disease and
coronary heart disease. The different threshold levels suggested by the receiver operator
characteristics (ROC) curve (CP=4.7μmol/L) (CHD=7.30 μmol/L) (CP+CHD=10.3
μmol/L) depicted that ADMA levels can be assessed in these conditions based on those
cut-off levels.
