VEGFA and familial dilated cardiomyopathy: In the vascular system, disturbances in the ubiquitin–proteasome system lead to elevated asymmetric dimethylarginine (ADMA) levels, which cause reduction in nitric oxide availability.[28] Increased levels of ADMA have been noted in patients with PPCM and DCM, and a decreased l-arginine/ADMA ratio is a predictor of mortality in DCM.[29] In addition, in late pregnancy, antiangiogenic factors are secreted to inhibit vascular endothelial growth factor signaling.