Abstract
Introduction: In a meta-analysis published in 2000, we derived pooled estimates for the association of left ventricular mass (LVM) and hypertrophy (LVH), as diagnosed by electrocardiography or echocardiography, with the deletion/insertion polymorphism in the angiotensin-converting enzyme gene (ACE D/I). Design: We updated the meta-analysis until May 2009, but we only considered echocardiographically phenotypes. Methods: We used random effects models to compute pooled estimates. Results: Of 831 screened studies, we reviewed 43 studies (10320 participants, 17.5% Asians, 82.4% Whites, 0.1%Blacks). Across 38 studies, both DD homozygotes (n = 2440) and DI heterozygotes (n = 4310) had higher (p ≤ 0.002) LVM or LVM index than II homozygotes (n = 2229). Across 21 studies with available data, this was due to increased mean wall thickness (MWT) with no difference in left ventricular internal diameter (LVID). Standardised differences (DD vs II) were 0.39 (95% confidence interval 0.20 to 0.59, p < 0.001) for LVM, 0.34 (0.085 to 0.59, p = 0.009) for MWT, and 0.066 (–0.049 to 0.18; p = 0.26) for LVID. Across 16 studies (4894 participants), the pooled odds ratios of LVH (vs II homozygotes) were 1.11 (0.91 to 1.36, p = 0.29) and 1.02 (CI 0.75 to 1.39, p = 0.88) for the DD and DI genotypes, respectively. For LVM, there was a deficit of small studies with null results, but for LVH we did not find publication bias. Sensitivity analyses were confirmatory. Conclusions: Our meta-analysis supports the hypothesis that the enhanced ACE activity associated with the D allele is associated with higher LV mass. Smaller sample size might explain the lack of significant association with LVH.
Published Version
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