Amino Acid Metabolism and Atherosclerotic Cardiovascular Disease

Despite significant advances in medical treatments and drug development, atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death worldwide. Dysregulated lipid metabolism is a well-established driver of ASCVD. Unfortunately, even with potent lipid-lowering therapies, ASCVD related deaths have continued to increase over the last decade, highlighting an incomplete understanding of the underlying risk factors and mechanisms of ASCVD. Accumulating evidence over the last decades indicates a correlation between amino acids and disease state. This review will explore the emerging role of amino acid metabolism in ASCVD, uncovering novel potential biomarkers, causative factors, and therapeutic targets. Specifically, the significance of arginine and its related metabolites - homoarginine and polyamines, branched-chain amino acids, glycine, and aromatic amino acids in ASCVD will be discussed. These amino acids and their metabolites have been implicated in various processes characteristic of ASCVD including impaired lipid metabolism, endothelial dysfunction, increased inflammatory response, and necrotic core development. Understanding the complex interplay between dysregulated amino acid metabolism and ASCVD provides new insight that may lead to the development of novel diagnostic and therapeutic approaches. While further research is needed to uncover the precise mechanisms involved, it is evident that amino acid metabolism plays a role in ASCVD.