L-arginine supplementation in peripheral arterial disease - No benefit and possible harm

Article

关键词: NITRIC-OXIDE SYNTHASE;    ASYMMETRIC DIMETHYLARGININE ADMA;    ENDOTHELIAL PROGENITOR CELLS;    STABLE ANGINA-PECTORIS;    ORAL L-ARGININE;    HYPERCHOLESTEROLEMIC RABBIT;    INTERMITTENT CLAUDICATION;    ENDOGENOUS INHIBITOR;    CARDIOVASCULAR RISK;    EXERCISE CAPACITY;   

DOI  :  10.1161/CIRCULATIONAHA.106.683656

来源: SCIE

【 摘 要 】

Background - L-Arginine is the precursor of endothelium- derived nitric oxide, an endogenous vasodilator. L-Arginine supplementation improves vascular reactivity and functional capacity in peripheral arterial disease ( PAD) in small, short-term studies. We aimed to determine the effects of long-term administration of L-arginine on vascular reactivity and functional capacity in patients with PAD. Methods and Results - The Nitric Oxide in Peripheral Arterial Insufficiency ( NO-PAIN) study was a randomized clinical trial of oral L-arginine ( 3 g/d) versus placebo for 6 months in 133 subjects with intermittent claudication due to PAD in a single-center setting. The primary end point was the change at 6 months in the absolute claudication distance as assessed by the Skinner-Gardner treadmill protocol. L-Arginine supplementation significantly increased plasma L-arginine levels. However, measures of nitric oxide availability ( including flow-mediated vasodilation, vascular compliance, plasma and urinary nitrogen oxides, and plasma citrulline formation) were reduced or not improved compared with placebo. Although absolute claudication distance improved in both L-arginine - and placebo-treated patients, the improvement in the L-arginine - treated group was significantly less than that in the placebo group ( 28.3% versus 11.5%; P = 0.024). Conclusions - In patients with PAD, long-term administration of L-arginine does not increase nitric oxide synthesis or improve vascular reactivity. Furthermore, the expected placebo effect observed in studies of functional capacity was attenuated in the L-arginine - treated group. As opposed to its short-term administration, long-term administration of L-arginine is not useful in patients with intermittent claudication and PAD.

【 授权许可】

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