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In this study, Wurtz and colleagues investigated to what extent elevated body mass index (BMI) within the normal weight range has causal influences on the detailed systemic metabolite profile in early adulthood using Mendelian randomization analysis. Please see later in the article for the Editors' Summary

Concomitant treatment with VA-ECMO and Impella may improve outcome in patients with cardiogenic shock compared with VA-ECMO only. Nevertheless, randomized studies are needed to validate these promising results further.

Abstract-As a competitive inhibitor of endothelial nitric oxide synthase, asymmetric dimethylarginine (ADMA) has been related to atherosclerotic disease. Little is known about the prognostic impact of baseline ADMA determination. Key Words: asymmetric dimethylarginine Ⅲ cardiovascular risk Ⅲ coronary artery disease T he endothelium plays a crucial role in the regulation of vascular tone. 1 A factor of prime importance to maintain endothelial homeostasis is nitric oxide. 2 Apart from its vasodilating effects, nitric oxide released from the endothelial nitric oxide synthase mediates many protective functions against atherosclerosis, such as reduction of adhesion molecule expression and leukocyte adhesion, as well as reduction of proinflammatory cytokines. It further controls smooth muscle cell proliferation and platelet aggregation and balances profibrinolytic activities.Substrate for endothelial nitric oxide synthesis is the amino acid L-arginine. 3 The endothelium is also capable of producing methylated amino acids such as asymmetric dimethylarginine (ADMA), which are able to out-compete L-arginine as a substrate for endothelial nitric oxide synthase, leading to endothelial dysfunction 4 (for review see Cooke 5 ). Importantly, endothelial dysfunction in coronary 6 and peripheral arteries 7 and the degree of oxidative stress within vascular tissue 7 have been recently identified to be independent predictors of future cardiovascular events.Evidence has emerged that circulating levels of ADMA are elevated in patients with cardiovascular risk factors and renal failure and are, in part, associated with the presence of endothelial dysfunction. 4,8 -11 However, it remains unclear whether measurement of levels of ADMA improves cardiovascular risk prediction, in particular, in comparison with traditional risk factors and newly discussed biomarkers such as C-reactive protein or B-type natriuretic peptide.With the present study, we, therefore, addressed the hypothesis that circulating levels of ADMA are independently Original