EVALUATION OF SERUM ASYMMETRIC DIMETHYLARGININE (ADMA) AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH PERIODONTAL DISEASE AND CORONARY HEART DISEASE

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 vii 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.