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J Am Coll Cardiol, 2003; 42:1864, doi:10.1016/j.jacc.2003.08.021
© 2003 by the American College of Cardiology Foundation
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LETTER TO THE EDITOR

Angiotensin-converting enzyme polymorphism (I/D) and coronary heart disease in young adults

Maria Martin Fernandez, MD

Department of Cardiology, Central Hospital of Asturias, Avd. Julian Clavería S/N, Oviedo 33006, Spain

J. J. Rodriguez Reguero, MD and Pelayo González, BM

mmartinf7{at}hotmail.com

The relationship between angiotensin-converting enzyme (ACE) gene polymorphism and several cardiovascular diseases such as myocardial infarction (MI) and its prognosis is controversial (1). In a recent issue of the Journal, Palmer et al. (2) conclude that ACE genotyping may provide additional prognosis information in patients with MI. These findings differ from previous studies.

A total of 163 male patients (<50 years old) with diagnosis of MI have been prospectively followed (medium 72 months) in our hospital. Clinical evolution, ACE levels, and ACE polymorphism were studied. A control group of 100 valvular patients with normal angiography was established (3–5). Angiographic study was done in 41% of patients (no lesions in 9%; 49% had single-vessel disease; 29% had two-vessel disease; and 12% had three-vessel disease). Medium-term prognosis was intermediate: three patients died, 2.5% of heart failure, 8% of reinfarction, 28% of unstable angina. The ACE levels were higher in the DD group.

No genotype differences existed between cases and control group (cases were: DD 44%; I/D 36%; II 20%; Control: DD 42%; I/D 39%; II 18%). No relationship existed between ACE group polymorphism and clinical evolution, but patients with two- and three-vessel disease were mostly DD (p < 0.01).

Thus, in this sample, we have not found a relationship between ACE polymorphism and MI prognosis, but there seems to be a relationship between DD and severity of coronary heart disease. Further investigation in several aspects (both coronary heart disease in the young and relationship with ACE polymorphism) and long-term studies are required to clarify this controversy.


   References
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 References
 

  1. Samani NJ, Thompson JR, O'Toole L, Channer K, Woods KL. A meta-analysis of the association of the deletion allele of the angiotensin-converting enzyme gene with myocardial infarction. Circulation. 1996;94:708–712[Abstract/Free Full Text]
  2. Palmer BR, Pilbrow AP, Yandle TG, et al. Angiotensin-converting enzyme gene polymorphism interacts with left ventricular ejection fraction and brain natriuretic peptide levels to predict mortality after myocardial infarction. J Am Coll Cardiol. 2003;41:729–736[Abstract/Free Full Text]
  3. Zimmerman FH, Cameron A, Fisher LD. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995;26:654–661[Abstract]
  4. Skinner JS, Albers CJ, Goudevenos J, et al. Prospective study of patients aged 55 years or less with acute myocardial infarction between 1981 and 1985: outcome 7 years and beyond. Br Heart J. 1995;74:604–610[Abstract/Free Full Text]
  5. Cole JH, Miller JI III, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol. 2003;41:521–528[Abstract/Free Full Text]



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Angiotensin-Converting Enzyme Insertion/Deletion Gene Polymorphic Variant as a Marker of Coronary Artery Disease: A Meta-analysis
Arch Intern Med, May 26, 2008; 168(10): 1077 - 1089.
[Abstract] [Full Text] [PDF]

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