However, in the majority of the studies we reviewed in which higher ADMA levels were associated with SVD26–30, patients had stroke or at least several vascular risk factors and pro-atherosclerotic conditions, such as increased age, hypertension, hypercholesterolemia, diabetes mellitus, insulin insensitivity, hyper-homocysteinemia, etc. leading to an unclear relationship between ADMA levels and other factors. This evidence concerns the gene INS and hyperhomocysteinemia.