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L-Arginine Therapy in Acute Myocardial Infarction: The Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) Randomized Clinical Trial
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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“Recent studies with TCW indicated that it is a rich source of cardioprotective factors viz. L-arginine [52], magnesium, potassium, calcium, and vitamin C, which are known to reduce the risk of coronary heart disease.”
From Research Progress in Coconut Water: A Review of Nutritional Composition, Biological Activities, and Novel Processing Technologies (2025) · cites this paper as [52]
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“Tungsten is a powerful tool for the study of molybdenum enzymes in cell and animal studies and has been found to alleviate atherosclerosis in ApoE−/− mice (833).”
From Sources of Vascular Nitric Oxide and Reactive Oxygen Species and Their Regulation (2019) · cites this paper as [833]
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Metadata
- 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
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2006-01-04
- Volume
- 295
- Issue
- 1
- Pages
- 58
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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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