Association between asymmetric dimethylarginine, its change and subclinical carotid atherosclerosis in metabolic dysfunction-associated steatotic liver disease

Background : Asymmetric dimethylarginine (ADMA) is a promising marker for assessing cardiovascular disease risk; however, it is unclear whether ADMA can predict subclinical carotid atherosclerosis (SCA) in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to investigate the association between baseline ADMA levels, changes in ADMA, and the risk of SCA in MASLD adults. Methods : A total of 600 MASLD adults were prospectively recruited. Serum ADMA concentrations were measured at baseline and one year of follow-up. The SCA was defined as the presence of carotid intima-media thickness and carotid plaque. Logistic regression and propensity score analysis was conducted to evaluate the association between baseline ADMA levels, changes in ADMA, and SCA risk. Results : The risk of SCA increased significantly with higher ADMA levels. Compared with participants in the lowest quartile of baseline ADMA levels, the multivariable-adjusted odds ratios were 0.989 (95% confidence interval, CI: 0.580-1.687), 1.853 (1.112-3.088) and 3.810 (2.055-7.063) for those in Quartile 2, Quartile 3 and Quartile 4, respectively. At 1-year follow-up, SCA progression occurred in 65 (12.45%) participants. Both absolute and relative changes in ADMA levels from baseline to one year were significantly associated with SCA progression, with adjusted relative risks being 1.056 (95% CI: 1.042-1.069) and 1.014 (95% CI: 1.011-1.018), respectively. Conclusion : ADMA levels associated with SCA in MASLD adults, while dynamic changes in ADMA could help predict the progression of SCA in these individuals.