Different types of statins might act differently in reducing plasma asymmetric dimethylarginine levels.

POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2013; 123 (10) To the Editor We read the article by Szpak et al.1 with interest. The authors investigated whether active or passive tobacco smoking may affect en‐ dothelial dysfunction markers such as asymme‐ tric dimethylarginine (ADMA), thrombomodulin (TM), plasminogen activator inhibitor‐1 (PAI‐1), and cotinine levels in patients with advanced co‐ ronary artery disease. Patients were divided into 2 groups according to the smoking status. The pla‐ sma levels of ADMA, TM, and PAI‐1 were found to be elevated in smokers when compared with those of nonsmokers. In addition, serum cotini‐ ne levels were found to be independently associa‐ ted with ADMA, TM, and PAI‐1 levels in the who‐ le study population. ADMA is an important endogenous compete‐ tive inhibitor of nitric oxide synthase, and eleva‐ ted levels of ADMA have been identified as an in‐ dependent risk factor for progression of athero‐ sclerosis.2 Statin treatment has been shown to reduce circulating ADMA levels.2 In the study by Szpak et al,1 the use of statin between smokers and nonsmokers was similar (P = 1.00). However, it should be stated that different types of statins might indeed act differently in altering plasma levels of ADMA. Specifically, rosuvastatin treat‐ ment in patients with hypercholesterolemia led to a significant reduction in plasma ADMA le‐ vels, which also appears to be related to the im‐ provement in endothelial function.2 Atorvastatin treatment in patients with nonischemic conges‐ tive heart failure had no clear effect on plasma ADMA levels.3 However, a recent study by Nishi‐ yama et al.4 found that atorvastatin treatment re‐ sulted in a significant decrease in ADMA levels in patients with ischemic stroke.4 Simvastatin also had no effect on ADMA levels.5 In conclusion, the type of statin should be considered when as‐ sessing the plasma levels of ADMA because dif‐ ferent types of statins might act differently even if the use of statin is similar between the groups.