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David T. Nash, MD

JAMA. 2002;287:1451-1452.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The article by Stühlinger et al¹ in this issue of THE JOURNAL deserves to be read at least twice by physicians involved in the care of patients with cardiovascular disease. Two readings are needed not because the article is difficult to fathom, but because the study demonstrates a potentially important relationship between insulin resistance and plasma concentrations of the endogenous nitric oxide synthase (NOS) inhibitor asymmetric dimethylarginine (ADMA). Elevated ADMA levels have been observed in various conditions, including hypertension, dyslipidemia, hyperglycemia, hyperhomocysteinemia, and renal failure, and are believed to be one cause of endothelial dysfunction in these conditions.² Elevated plasma ADMA concentrations are also associated with an increased risk of cardiovascular disease.³

The objectives of the study by Stühlinger et al were to evaluate a possible relationship between tissue insulin sensitivity and plasma ADMA levels, and to determine whether pharmacological treatment designed to increase insulin sensitivity . . . [Full Text of this Article]

Author Affiliation: Syracuse Preventive Cardiology Center, Syracuse, NY.

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