There is a growing clinical evidence to support the hypothesis that asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase is a new independent cardiovascular risk factor. ADMA mediates endothelial dysfunction in lipid disorders, coronary artery disease, chronic heart failure, diabetes mellitus and hypertension. The aim of this review was to summarize the latest evidence from epidemiological and prospective clinical trials and to emphasize the role of ADMAas a cardiovascular risk factor.