Cited by 357Cardiovascular Health and Disease PreventionNitric Oxide and Endothelin EffectsAcute Myocardial Infarction Research

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L-Arginine Therapy in Acute Myocardial Infarction: The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial

Schulman, Steven P., Becker, Lewis C., Kass, David A., Champion, Hunter C., Terrin, Michael L., Forman, Sandra, Ernst, Kavita V., Kelemen, Mark D., Townsend, Susan N., Capriotti, Anne, Hare, Joshua M., Gerstenblith, Gary·2006·JAMA

DOI 10.1001/jama.295.1.58

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Abstract

CONTEXT: The amino acid L-arginine is a substrate for nitric oxide synthase and is increasingly used as a health supplement. Prior studies suggest that L-arginine has the potential to reduce vascular stiffness. OBJECTIVE: To determine whether the addition of L-arginine to standard postinfarction therapy reduces vascular stiffness and improves ejection fraction over 6-month follow-up in patients following acute ST-segment elevation myocardial infarction. DESIGN AND SETTING: Single-center, randomized, double-blind, placebo-controlled trial with enrollment from February 2002 to June 2004. PATIENTS: A total of 153 patients following a first ST-segment elevation myocardial infarction were enrolled; 77 patients were 60 years or older. INTERVENTION: Patients were randomly assigned to receive L-arginine (goal dose of 3 g 3 times a day) or matching placebo for 6 months. MAIN OUTCOME MEASURES: Change in gated blood pool-derived ejection fraction over 6 months in patients 60 years or older randomized to receive L-arginine compared with those assigned to receive placebo. Secondary outcomes included change in ejection fraction in all patients enrolled, change in noninvasive measures of vascular stiffness, and clinical events. RESULTS: Baseline characteristics, vascular stiffness measurements, and left ventricular function were similar between participants randomized to receive placebo or L-arginine. The mean (SD) age was 60 (13.6) years; of the participants, 104 (68%) were men. There was no significant change from baseline to 6 months in the vascular stiffness measurements or left ventricular ejection fraction in either of the 2 groups, including those 60 years or older and the entire study group. However, 6 participants (8.6%) in the L-arginine group died during the 6-month study period vs none in the placebo group (P = .01). Because of the safety concerns, the data and safety monitoring committee closed enrollment. CONCLUSIONS: L-arginine, when added to standard postinfarction therapies, does not improve vascular stiffness measurements or ejection fraction and may be associated with higher postinfarction mortality. L-arginine should not be recommended following acute myocardial infarction. Clinical Trial Registration ClinicalTrials.gov, NCT00051376.

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Authors: Schulman, S. P., Becker, L. C., Kass, D. A., Champion, H. C., Terrin, M. L., Forman, S., Ernst, K. V., Kelemen, M. D., Townsend, S. N., Capriotti, A., Hare, J. M., & Gerstenblith, G.
Affiliations: Johns Hopkins University (US)
University of Maryland, Baltimore (US)
Maryland Medical Research Institute (US)
Corresponding author: Schulman, Steven P.
ORCID: Schulman, Steven P.
Becker, Lewis C.
Kass, David A.
Terrin, Michael L.
Hare, Joshua M.
Gerstenblith, Gary
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2006-01-04
Volume: 295
Issue: 1
Pages: 58
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.295.1.58
OpenAlex: W2112439550
Cited by: 357
References: 54
Citations by year: 2026: 12 · 2025: 8 · 2024: 7 · 2023: 10 · 2022: 14 · 2021: 9 · 2020: 13 · 2019: 13 · 2018: 18 · 2017: 20 · 2016: 22 · 2015: 19 · 2014: 18 · 2013: 22 · 2012: 21
FWCI: 19.67
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01hl070059-04)
National Heart, Lung, and Blood Institute (HL70059)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords: L-arginine, acute myocardial infarction, ST-elevation myocardial infarction, vascular stiffness, left ventricular ejection fraction, nitric oxide synthase, mortality, older adults, dietary supplementation
MeSH terms: Aged, Arginine, Double-Blind Method, Female, Humans, Male, Middle Aged, Myocardial Infarction, Stroke Volume, Ventricular Function, Left, Atherosclerosis

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L-Arginine Therapy in Acute Myocardial Infarction: The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial

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