Abstract
BackgroundAngiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms have been associated with acute coronary syndrome (ACS); however, several controversial results have also been found in different studied populations. This hospital-based, emergency room, case-control study in Taiwan retrospectively investigated 111 ACS patients, and 195 non-coronary subjects as a control group, to study the effects of ACE I/D polymorphism in the most urgent ACS patients. ACE I/D polymorphisms were determined by polymerase chain reaction-based assays and their associations with ACS risk, severity, and sudden cardiac death were determined.ResultsThe ACE DD genotype was associated with ACS incidence. The DD genotype was associated with a significant 4-fold higher risk of ACS in multivariate analysis (odds ratio (OR) = 4.295; 95% confidence interval (CI): 1.436-12.851, p = 0.009), and a 3.35-fold higher risk of acute myocardial infarction. DD genotype carriers also had more than 3-fold higher risks of stenosis in all the three coronary arteries, left anterior descending artery infarction, and anterior wall infarction. In addition, the DD genotype was also associated with a higher risk of sudden cardiac death (OR = 6.484, 95% CI: 1.036-40.598, p = 0.046).ConclusionsThis study demonstrated that the ACE DD genotype is an independent risk factor for ACS, and in particular, for acute myocardial infarction. In addition, the ACE DD genotype is also associated with greater ACS severity and a higher risk of sudden cardiac death. ACE genotyping is recommended for patients with a history of ACS, and more intensive preventive care is suggested for patients with the DD genotype.
Highlights
Angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms have been associated with acute coronary syndrome (ACS); several controversial results have been found in different studied populations
The ACE DD genotype is associated with greater ACS severity, including more stenosed vessels, greater occlusion of the left anterior descending branch, and a greater risk of anterior wall myocardial infarction (Table 3) and of sudden cardiac death (Table 4)
The ACE DD genotype was reported to be associated with coronary artery disease (CAD) risk in several studies including ECTIM [7], INSERM [8], ISIS [10] and CORGENE [28] cohorts, and subsequent studies revealed that the D allele or DD genotype may confer effects mainly on the onset of ACS or MI [29] by modifying ACE abundance or activity, and contributing to increases in plaque instability, ulceration and thrombosis [30]
Summary
Angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms have been associated with acute coronary syndrome (ACS); several controversial results have been found in different studied populations. This hospital-based, emergency room, case-control study in Taiwan retrospectively investigated 111 ACS patients, and 195 non-coronary subjects as a control group, to study the effects of ACE I/D polymorphism in the most urgent ACS patients. Genetic polymorphisms in ACE-related pathways, including the angiotensin II type 1 receptor (AT1R) and AT2R, have been associated with MI-related arrhythmias and risk of sudden cardiac arrest [18]. ACE DD and AT1R 1166 CC genotypes have been linked with a greater risk of diastolic heart failure [19]
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