Association of angiotensin-converting enzyme insertion/deletion polymorphism with obesity,cardiovascular risk factors and exercise-mediated changes in Korean women

This study examined whether the angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) polymorphism is associated with obesity, cardiovascular risk factors and 12-week exercise-mediated changes in Korean women. A total of 105 subjects were divided into three groups as II, ID and DD genotype groups based upon ACE I/D genotypes. Body composition and cardiovascular risk factors were compared among the three groups, and the association of ACE I/D genotypes with obesity and hypertension was evaluated. Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels were higher (P < 0.05) in the DD genotype than in II or ID genotypes. D allele frequency in ACE I/D gene had a higher (P = 0.063) trend in the hypertensive group than the normotensive group. The DD genotype had a trend to develop (odds ratio 4.032, P = 0.086) more hypertension than the II genotype. The II and ID genotypes showed a significant (P < 0.05) decrease in intima media thickness of the carotid artery after an exercise intervention, whereas the DD genotype showed an increase. In conclusion, there is a trend towards association of ACE I/D polymorphism with hypertension but not with obesity. Exercise-mediated changes did not differ significantly among genotypes except IMTCA.     

A study of gene--environment interaction on the gene for angiotensin converting enzyme: a combined functional and population based approach

Introduction: Studies on the role of the insertion/deletion (I/D) polymorphism of the gene coding for angiotensin converting enzyme (ACE) in atherosclerosis have been inconsistent. In a meta-analysis, we recently showed that this relationship is stronger in high risk populations. In this paper, we used a combined functional and population based approach to investigate the gene–environment interaction of the ACE I/D polymorphism in relation to carotid artery wall thickness.

Methods: The study was part of the Rotterdam Study, a prospective population based cohort study. In 5321 subjects, IMT was measured in the carotid arteries by ultrasonography and ACE genotype was determined by size analysis of polymerase chain reaction products.

Results: In multiple regression analysis, I/D polymorphism and smoking were the main determinants for plasma ACE activity (r² = 0.28). There was a positive association between the D allele of the I/D polymorphism and carotid artery thickness among current smokers (p = 0.03). Subjects carrying only one of the risk factors (smoking or the D allele) did not show significant differences in IMT compared with the non-/former smokers group carrying two II alleles, while carriers of both risk factors had significant higher IMT. The association was not present in non-/former smokers.

Discussion: The results provide further evidence that genetic and environmental factors interact in the formation of the arterial lesions. This study shows that large population based studies can be extremely helpful in unravelling the genetic origin of complex diseases such as atherosclerosis.

     

Physical activity and angiotensin-converting enzyme gene polymorphism in mild hypertensives

It has been suggested that the insertion(I) allele of the I/deletion(D) polymorphism of the angiotensin converting enzyme (ACE) gene is associated with endurance exercise and increased physical conditioning in response to this type of exercise. To investigate the association between the ACE I/D polymorphism and physical activity status in 355 never treated, stage I hypertensives (265 men, 90 women, mean age: 33 +/- 9 years), in whom power exercise is contraindicated, participants of the HARVEST study. Physical activity was assessed using a standardized questionnaire. BMI and age did not vary among genotypes. None of active subjects performed power oriented exercises. ACE I/D frequencies (II-18%, ID-55%, DD-27%) were in Hardy-Weinberg equilibrium. Sedentary lifestyle was more common among DD than II hypertensives (76% in DD, and 48% in II, Chi(2) = 13.9, P = 0.001). In stepwise MANOVA using age, marital status, profession, sex, and ACE genotype as predictors of physical activity, marital status (F = 24.4, P < 0.0001) and ACE genotype (F = 16.03, P < 0.0001) contributed to more than 50% of the variance in physical activity status of the population. Our results suggest that the ACE I/D polymorphism may be a specific genetic factor associated with physical activity levels in free-living borderline and mild hypertensive subjects.     

Risk factor–gene interaction in carotid atherosclerosis: effect of gene polymorphisms of renin-angiotensin system

The risk factor–gene interaction in carotid atherosclerosis was investigated in 205 community-dwelling healthy subjects aged 50 years or more in Japan. The intima–media thickness (IMT) of the common carotid artery was evaluated by ultrasonography with a 7.5-MHz probe. Gene polymorphisms were determined for each subject with angiotensin-converting enzyme (ACE) insertion/deletion (I/D), angiotensinogen (AGT) M235T, angiotensin II type 1 receptor (AT1R) A1166C, and apolipoprotein E (apoE) genotypes. There was no genotype-specific difference in carotid IMT among any genes examined. Combinations of genotypes did not increase carotid IMT compared with subjects without these genotypes. In the total population, multiple regression analysis showed that age, systolic blood pressure (SBP), sex, and body mass index (BMI) were significantly associated with carotid IMT. However, the association between risk factors and IMT was genotype-specific. Age was significantly associated with IMT in ACE D carriers, but not in subjects with the ACE II genotype. Analysis of covariance adjusted with other risk factors showed that the age-dependent change in IMT was significantly different between subjects with the ACE II genotype and the ACE D carriers (F[1.196] = 4.97; P = 0.027). Similarly, the regression of IMT on SBP was significantly different between AGT TT and AGT MT + MM (F[1.196] = 7.20; P = 0.0079). The regression of IMT on BMI was also significantly different between apo E4 carriers and noncarriers (F[1.196] = 6.78; P = 0.0099). Furthermore, general linear model analysis with risk factors, genotype, and risk factor-genotype interactions revealed that the age^*ACE genotype interaction, the SBP^*AGT genotype interaction, and the BMI^*apoE genotype interaction were significantly associated with IMT. These findings further support the role of risk factor-gene interaction in carotid atherosclerosis. Received: January 5, 2001 / Accepted: February 5, 2001     

Association of the ACE gene polymorphism with the progression of autosomal dominant polycystic kidney disease

Renin-angiotensin system is considered important in the genesis of hypertension and development of end-stage renal disease (ESRD) in autosomal dominant polycystic kidney disease (ADPKD). The angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism has been associated with susceptibility to the development of some renal diseases. We investigated the association of ACE gene polymorphism with the progression to hypertension and ESRD in 108 patients with ADPKD. The ACE I/D polymorphism was amplified with the flanking primers by polymerase chain reaction. In patients genotyped for ACE gene polymorphism, the frequencies of DD (15%), ID (51%) and II (34%) genotypes were similar to those of the general population. Of the 108 patients, 64 (59%) developed hypertension and 24 (22%) reached ESRD at the time of study. The prevalence of hypertension was not significantly different among the three genotypes. The mean renal survival time was 53-6 yr in II genotype, 55+/-10 yr in ID genotype and 52+/-9 yr in DD genotype which was not significantly different among them. Cumulative renal survival was not significantly different either. There was no association of ACE gene polymorphism with the prevalence of hypertension and renal survival in ADPKD. We suggest that ACE I/D polymorphism is not an important modifying gene in the progression of ADPKD.     

Association of angiotensin-converting-enzyme gene polymorphism with the depressor response to mild exercise therapy in patients with mild to moderate essential hypertension

We studied the association of angiotensin I-converting enzyme (ACE) gene polymorphism with the depressor response to exercise therapy in 64 Japanese subjects with mild to moderate essential hypertension. Each subject performed 10 weeks of mild (lactate threshold intensity: approximately 50% maximum oxygen consumption) exercise therapy on a bicycle ergometer. Systolic blood pressure (SPB), diastolic blood pressure (DPB), and mean arterial pressure (MAP) were significantly decreased by exercise therapy in subjects with the ACE-II and ID genotypes but not in DD subjects. The time-by-genotype interaction effects were significant for DBP and MAP. According to a multiple logistic regression analysis, the age- and baseline plasma renin activity-adjusted relative risk (odds ratio) for the lack of a depressor response conferred by the D allele (assuming an additive effect) was 2.72 [95% confidence interval (CI), 1.07-6.91; p = 0.034]; for DD genotypes, as compared with the DI and II genotypes (assuming that the D allele is recessive), it was 11.7 (95% CI, 2.25-60.6; p = 0.003). ACE gene I/D polymorphism is associated with the depressor response of essential hypertensives to mild exercise therapy, which suggests that genetic features may underlie, at least in part, the heterogeneity of the depressor response in essential hypertensives to mild exercise therapy.     

血管紧张素转换酶基因插入/缺失多态性在人群中的分布及其与原发性高血压的关系

目的　研究血管紧张素转换酶 (angiotensin converting enzyme,ACE)基因 I/ D多态性在人群中的分布特征及其与原发性高血压的关系。方法　应用 PCR方法对 2 966名开滦矿务局职工进行 ACEI/ D基因型检测 ,并分析比较。结果　研究人群中 II、ID、DD基因型分布频率分别为 41.5%、3 8.4%、2 0 .1% ,I、D等位基因分布频率分别为 60 .7%和 3 9.3 %。ACE DD基因型在高血压组 (13 0 8例 )和对照组(1658名 )的频率分别为 18.9%和 2 1.0 % ,差异无显著性 (P>0 .0 5) ,按年龄及性别分层后差异也无显著性(P>0 .0 5)。DD基因型及 D等位基因分布频率有随年龄的增长而下降的趋势 (P<0 .0 0 1)。结论　 ACE I/D多态性与原发性高血压无关 ,基因型及等位基因的分布因年龄不同而不同 ,并提示具有 DD基因型特征的人群早期死亡危险的增加     

西藏藏族人群血管紧张素转换酶基因多态性分布

目的:探讨西藏拉萨、那曲地区藏族健康人群血管紧张素转换酶(ACE)基因第16内含子287bpAlu顺序插入/缺失(I/D)多态性分布。方法:采用聚合酶链反应(PCR)方法检测ACE基因型。结果:76例拉萨藏族人ACE基因型频率分别为Ⅱ=0．395,ID=0．316,DD=0．289,等位基因频率分别为Ⅰ=0．553,D=0．447。81例那曲藏族人ACE基因型频率分别为Ⅱ=0．346,ID=0．444,DD=0．210,等位基因频率分别为Ⅰ=0．568,D=0．432。结论:拉萨、那曲地区藏族人ACE基因型及等位基因频率分布无显著差异;西藏藏族与英国白人和美国黑人相比基因型及等位基因频率均存在显著性差异,但与韩国人及日本人相似。     

The angiotensin converting enzyme genetic polymorphism in acute coronary syndrome--ACE polymorphism as a risk factor of acute coronary syndrome.

The deletion polymorphism of angiotensin converting enzyme (ACE) genotype has been reported as an independent risk factor for the development of myocardial infarction (MI). However there are conflicting data showing no relationship between the ACE genotype and coronary artery disease. The present study was performed to investigate the correlation between ACE genetic polymorphism and acute coronary syndrome by comparing the distribution of ACE genotypes and ACE activities in patients with acute MI and unstable angina with those in control group. The frequency of genotype DD was significantly higher in patients with acute coronary syndrome than in controls. Logistic regression analysis showed that ACE polymorphism affected the development of acute coronary syndrome in recessive pattern of D allele. When we divided the patients into MI and unstable angina groups, the frequencies of genotype DD and D allele were significantly higher in unstable angina group than in MI or control groups. In the patients with MI, the frequency of D allele was significantly higher in patients without previous angina than in those with previous angina. There was no significant difference in ACE genotype or allelic frequency according to the severity of coronary lesions. The ACE genotype was associated with marked differences of ACE activity, but there was no difference between the patient and control groups for each genotype. In conclusion, the genotype DD of ACE gene associated with acute coronary syndrome, but not with the severity of coronary artery lesion. These results showed that the genotype DD of ACE gene might be associated with acute coronary syndrome by another mechanism rather than the coronary atherosclerosis.     

Genetic variation of the angiotensin-converting enzyme gene: increased frequency of the insertion allele in Koreans

In view of the clinical importance of angiotensin-converting enzyme (ACE) as a major marker for cardiovascular diseases, we investigated insertion/deletion ( I/D ) polymorphism of the ACE gene in Koreans. Genotype frequencies were examined by polymerase chain reaction in 171 patients with coronary artery disease (CAD) and 120 healthy subjects. Allele frequencies of ACE polymorphism in Koreans were not significantly different between patient and control groups. In addition, association between ACE genotypes and the number of stenosed coronary arteries was not detected. ACE genotypes in the CAD group were not associated with body mass index and plasma lipid levels. Thus, our results suggest that, at least in Koreans, I/D polymorphism of the gene is unlikely to be a useful marker for CAD subjects. However, the I allele frequency of Koreans (0.58) was higher than that of Caucasian populations (0.47) but lower than that of Samoan (0.91) and Yanomami (0.85) populations. Here, we discuss the clinical and ethnic importance of ACE polymorphism.     

妊娠高血压综合征患者血管紧张素转化酶基因多态性研究

目的探讨血管紧张素Ⅰ转化酶（ＡＣＥ）基因第１６内含子插入／丢失多态性与妊娠高血压综合征（简称妊高征）的关系。方法应用聚合酶链反应,检测６０例妊高征患者及对照组７６例正常孕妇的ＡＣＥ基因中第１６内含子是否有Ａｌｕ重复结构存在。结果６０例妊高征患者中ＡＣＥ基因Ｉ型和ＤＤ型频率分别为１５％（９／６０）和６５％（３９／６０）,而７６例正常晚期妊娠妇女中则分别为５０％（３８／７６）和１０．５％（８／７６）。妊高征组的缺失型（Ｄ型）ＡＣＥ等位基因出现频率为０．７５,高于对照组的０．３０８,差异有显著性（Ｐ＜０．０１）。结论提示Ｉ型基因是妊高征的保护性基因,ＤＤ型基因是妊高征的易感基因,ＡＣＥ基因的缺失多态性（ＤＤ）可能与妊高征的发病有关。     

Angiotensin-converting enzyme gene polymorphism in patients with systemic lupus

The renin-angiotensin-aldosterone system (RAAS) has been considered one of the probable pathophysiologic mechanisms involved in disease progression. Genetic polymorphism of the RAAS has been associated with the clinical course of renal disease. One of the genetic polymorphisms is a deletion or insertion of a 287 base pair fragment in intron 16 of the angiotensin-converting enzyme (ACE) gene. It is known that ACE gene polymorphism is present in humans and that it is associated with an increased risk of cardiovascular diseases, renal disease progression and sarcoidosis. In this study, the potential significance of ACE gene polymorphism in patients with systemic lupus erythematosus (SLE) was investigated. ACE gene polymorphism was determined in 18 patients with SLE and in 21 healthy volunteers as a control group. The mean age of patients was 38.5 years. All patients had a mean follow-up of 30.7 +/- 20.2 months (range 5-95 months). ACE genotypes were determined by the method of polymerase chain reaction. Proteinuria and creatinine were also followed. The frequency of DD, ID and II genotypes was 50%, 28% and 22% in SLE patients and 25%, 50% and 25% in healthy controls, respectively. DD genotype was more common in SLE patients than in the control group. The patients with II genotype had lower proteinuria and creatinine level than those with DD genotype (p < 0.05). The time to disease remission was shorter in patients with II genotype (p < 0.05). Study results indicated an increased frequency of D allele in SLE patients. The increased ACE activity in these patients pointed to the need of further studies of ACE gene polymorphism in SLE.     

肾素-血管紧张素系统基因多态性与2型糖尿病脑梗塞的关系

目的研究肾素-血管紧张素系统(renin-angiotensin system,RAS)中血管紧张素Ⅱ的1型受体(type1angiotensin Ⅱ receptor,AT1R)基因A1166C多态及血管紧张素Ⅰ转化酶(angiotensin1-converting enzyme,ACE)基因插入/缺失(I/D)多态与中国汉族2型糖尿病(type 2 diabetes     

冠心病、原发性高血压人群ACE基因多态性分布及序列测定

目的研究血管紧张素转换酶（ＡＣＥ）基因插入／缺失（Ｉ／Ｄ）多态性在冠心病（ＣＡＤ）、原发性高血压（ＥＨ）和健康人群中的分布,并进行序列分析。方法以多聚酶链反应（ＰＣＲ）方法检测了１３７例ＣＡＤ患者、４２例ＥＨ患者和６３例健康人群的ＡＣＥ基因型,以荧光标记自动测序法测定Ｄ和Ｉ等位基因序列。结果ＣＡＤ组ＤＤ型ＡＣＥ基因出现频率显著高于对照组（０．４５对０．２１,Ｐ＜０．０１）,而ＥＨ组与对照组比较无显著差异。Ｄ等位基因长１９１ｂｐ,Ｉ等位基因长４７９ｂｐ,其核苷酸序列与国外文献报道略有不同。结论ＡＣＥ基因Ｉ／Ｄ多态性是ＣＡＤ发病的独立危险因素,与ＥＨ无相关,ＡＣＥ基因１６内含子中一段２８８ｂｐ的插入片段造成Ｉ／Ｄ多态性。     

A polymorphism in the angiotensin 1-converting enzyme gene is associated with damage to cerebral cortical white matter in Alzheimer's disease

The impact of the insertion (I)/deletion (D) (I/D) polymorphism in the angiotensin 1-converting enzyme (ACE) gene on the extent of white matter myelin loss (ML) was investigated in four regions of the cerebral cortex in an autopsy-confirmed series of 93 patients with Alzheimer's disease (AD). The possible influence of APO E epsilon4 allele acting in concert with ACE D allele was assessed. The extent of ML did not differ between D/D, I/D and I/I genotype groups when data from all four brain regions were combined. However, separate analysis showed that the frontal and temporal cortex tended to be affected more severely by ML in patients with D/D genotype compared to those with I/D and I/I genotypes. Stratification according to APO E epsilon4 allele revealed a greater overall ML in patients bearing at least one copy of ACE D allele and one APO E epsilon4 allele, especially in individuals homozygous for both. The APO E epsilon4 allele may therefore act synergistically in patients with AD (and other subjects) bearing ACE D/D genotype to increase the risk of ML, perhaps through transient ischaemic episodes consequent upon poor cardiac output associated with coronary atherosclerosis in patients with the APO E epsilon4 allele.     

The ACE deletion allele is associated with Israeli elite endurance athletes

An Alu insertion (I)/deletion (D) polymorphism in the angiotensin I converting enzyme (ACE) gene has been associated with ACE activity. Opposing effects on elite athletic performance have been proposed for the I and D alleles; while the D allele favours improved endurance ability, the I allele promotes more power-orientated events. We tested this hypothesis by determining the frequency of ACE ID alleles amongst 121 Israeli top-level athletes classified by their sporting discipline (marathon runners or sprinters). Genotyping for ACE ID was performed using polymerase chain reaction on DNA from leucocytes. The ACE genotype and allele frequencies were compared with those of 247 healthy individuals. Allele and genotype frequencies differed significantly between the groups. The frequency of the D allele was 0.77 in the marathon runners, 0.66 in the control subjects (P = 0.01) and 0.57 in the sprinters (P = 0.002). The ACE DD genotype was more prevalent among the endurance athletes (0.62) than among the control subjects (0.43, P = 0.004) and the power athletes (0.34, P = 0.004). In the group of elite athletes, the odds ratio of ACE DD genotype being an endurance athlete was 3.26 (95% confidence interval 1.49-7.11), and of ACE II genotype was 0.41 (95% confidence interval 0.14-1.19). We conclude that in Israeli elite marathon runners the frequency of the ACE D allele and ACE DD genotype seems to be higher than in sprinters, suggesting a positive association between the D allele and the likelihood of being an elite endurance athlete in some ethnic groups.     

Angiotensin-converting enzyme gene insertion/deletion polymorphism in Korean patients with systemic sclerosis

To determine whether angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism is associated with the development and clinical features of systemic sclerosis (SSc) in Korean, we studied seventy two Korean patients with SSc fulfilling the ACR preliminary classification criteria. The controls were 114 healthy, disease free Koreans. ACE I/D genotypes were determined by PCR method using oligonucleotides. Sixty eight patients (94.4%) were women and age at diagnosis was 43.5+/-12.6 yr old (mean+/-SD). Thirty nine patients (54.2%) had a diffuse type of SSc. There were no statistical differences in the frequencies of all ACE I/D genotypes and D allele between patients and controls, and neither between diffuse and limited types of SSc. ACE I/D gene polymorphism was not associated with the development of SSc in Korea. The investigation for the pathogenesis of SSc requires more studies about the role of other candidate genes such as endothelin, TGF-beta, nitric oxide, or angiotensin II receptor in addition to the ACE genes.     

血管紧张素转化酶基因多态性与高血压病合并脑梗塞的探讨

目的探讨血管紧张素转化酶（ＡＣＥ）基因插入／缺失（Ｉ／Ｄ）多态性与中国人高血压病合并脑梗塞的关系。方法应用聚合酶链反应（ＰＣＲ）方法检测６２例正常人，５５例高血压病无心脑血管合并症患者，４４例高血压病合并脑梗塞患者的ＡＣＥ基因型。结果ＡＣＥ基因Ｉ／Ｄ多态性与高血压病无相关关系。但高血压合并脑梗塞的ＤＤ基因型频率２９．６％及Ｄ等位基因频率５６．８％显著高于正常对照组的１２．９％和３８．７％（分别Ｐ＜０．０５和Ｐ＜０．０１），以及高血压无心脑血管合并症组的１２．８％和４０％（分别Ｐ＜０．０５，Ｐ＜０．０２）。结论ＡＣＥ基因缺失型可能是中国人高血压病合并脑梗塞发病的重要遗传因素     

原发性高血压患者中医辨证分型与ACE基因I/D多态性的相关性研究

目的:探讨原发性高血压不同中医证型与血管紧张素转换酶(ACE)基因多态性分布的相关性。方法:选择原发性高血压患者120例,中医辨证分型为肝火旺盛型、阴虚阳亢型、阴阳两虚型、痰湿壅盛型,选取正常对照组30例,并采用PCR方法检测ACE基因的多态性。结果:ACE基因DD型在阴虚阳亢组与正常对照组之间显著差异(P0.05),而ACE基因Ⅱ、ID型及等位基因与正常对照组比较无显著差异(P0.05)。各证型组之间两两比较ACE基因型和等位基因之间都无显著差异(P0.05)。结论:原发性高血压阴虚阳亢型可能与ACE基因DD型有关联。     

The angiotensin-converting enzyme (ACE) genetic polymorphism: its relationship with plasma ACE level and myocardial infarction

The angiotensin-converting enzyme (ACE) is a key factor in the production of angiotensin II and in the degradation of bradykinin, two important peptides involved in vascular physiology. Plasma and cellular ACE levels in humans are influenced by an insertion (I)/deletion (D) polymorphism of the ACE gene, the ACE I/D polymorphism. The D allele has a frequency of approximately 0.53 in Caucasian populations and is codominantly associated with higher levels of ACE. We have studied this polymorphism in a large multicenter case-control study (the ECTIM study) and found that the D allele was associated with a parental history of fatal myocardial infarction (MI) in the controls and was more frequent in male patients with MI than in controls. This case-control difference was compatible with a codominant effect of allele D on the risk of MI with relative risks of 1.57 for DD vs II and 1.26 for ID vs II (test for trend p < 0.003). In subjects at low risk of MI (plasma ApoB < 1.25 g/1 and body mass index < 26 kg/m²), the relative risk of DD vs ID + II was 2.7 (p < 0.0005). The results were very homogeneous in the four populations included in the study. In a family study, using linkage-segregation analysis, we have shown that the ACE I/D polymorphism is a marker for an unknown functional polymorphism (ACE S/s) which appears to be a new independent risk factor for MI.