Levels of Asymmetric Dimethylar Ginine and Risk of Neurovascular Diseases: A Systematic Review and Meta-Analysis

Scope: The purpose of this study was to provide clear evidence that reliably quantifies the association of Asymmetric dimethylarginine (ADMA) levels with the risk of neurovascular diseases.

Methods and results: The Pubmed, Web of Science, and Embase were systematically searched to identify eligible studies published until August 2024. A total of 31 eligible studies were identified. Pooled results indicated that patients with stroke yielded a higher ADMA level than healthy controls [standardized mean difference (SMD) = 1.02, 95% CI = 0.92-1.12, P = 0.001]. Subgroup analyses showed that geographical location, sample type, number of events and the proportion of male participants were statistically significant sources of heterogeneity. Similarly, a significant association with a pooled risk ratio (RR) of 1.60 (95% CI = 1.60-1.91) was shown between ADMA exposure and the risk of stroke from seven cohort studies. There was a statistically significant difference between ADMA level and small vessel disease (SVD) (SMD = 0.33, 95% CI = 0.07-0.58, p = 0.001). In addition, migraine patients tend to have elevated ADMA levels compared to healthy controls (SMD = 0.39, 95% CI = 0.11-0.67, P = 0.001).

Conclusions: Our results indicate that ADMA levels have significant effects in patients with stroke, SVD, and migraine.