Di Pasquale Pietro, Cannizzaro Sergio, Paterna Salvatore
Division of Cardiology, Paolo Borsellino, G.F. Ingrassia Hospital, Via Val Platani 3, 90144 Palermo, Italy.
Eur J Heart Fail. 2004 Jan;6(1):11-6. doi: 10.1016/j.ejheart.2003.07.009.
There has been an increase in research into the association between angiotensin-converting enzyme (ACE) gene deletion polymorphism and cardiovascular disease, with conflicting results. The present prospective long-term study was conducted to evaluate whether the DD genotype could also be associated with a higher prevalence of hypertension in healthy subjects, over 6 years of follow-up.
684 healthy volunteers (aged, 25-55 years): normotensive and free of cardiovascular diseases, with acceptable echocardiographic window. All subjects had to have a normal electrocardiogram (ECG) and echocardiogram (ECHO) at entry.
All subjects underwent a complete physical examination, 12-lead ECG and ECHO, and venous blood samples were drawn for DNA analysis and cholesterol. All subjects had a clinical evaluation each year for the 6 year duration of the study.
All 684 subjects completed 6 years of follow-up. We identified three genetically distinct groups. The ACE-DD group (n=225, 80F/145M, mean age 43.4+/-7.6 years) had 42 hypertensive subjects (18.3%), 5 heart failure (HF) subjects and 6 subjects with acute coronary syndromes (ACS). There was no association between family history, smoking habit, hypercholesterolemia and events. The ACE-ID group (n=335, 116F/219M, mean age 43.6+/-7 years) had 16 hypertensive subjects (4.7%) and 3 subjects with ACS. The ACE-II group (n=124, 45F/79M, mean age 42.5+/-6.9 years) had 2 hypertensive subjects (1.6%) and 1 HF subject. The incidence of hypertension and cardiovascular events was significantly higher in the ACE-DD group (53 cases, 23%) than in the ACE-ID and ACE-II groups (20 and 3 cases, 5.9 and 2.4%, respectively), P=0.0001. The higher incidence of hypertension was observed in the older age groups (36-45 and 46-55 years) with ACE-DD and ACE-ID genotypes.
Our data suggest that ACE-DD polymorphism is associated with a higher incidence of hypertension in baseline healthy subjects, irrespective of other risk factors. The higher incidence of hypertension was apparent predominantly in the older age groups.
关于血管紧张素转换酶（ACE）基因缺失多态性与心血管疾病之间关联的研究日益增多，但其结果相互矛盾。本前瞻性长期研究旨在评估在6年的随访期内，DD基因型是否也与健康受试者中更高的高血压患病率相关。
684名健康志愿者（年龄25 - 55岁）：血压正常且无心血管疾病，具备可接受的超声心动图检查窗口。所有受试者在入组时心电图（ECG）和超声心动图（ECHO）均正常。
所有受试者均接受全面体格检查、12导联心电图和超声心动图检查，并采集静脉血样本进行DNA分析和胆固醇检测。在为期6年的研究中，所有受试者每年进行一次临床评估。
所有684名受试者均完成了6年的随访。我们识别出三个基因不同的组。ACE - DD组（n = 225，80名女性/145名男性，平均年龄43.4±7.6岁）有42名高血压受试者（18.3%）、5名心力衰竭（HF）受试者和6名急性冠状动脉综合征（ACS）受试者。家族史、吸烟习惯、高胆固醇血症与这些事件之间无关联。ACE - ID组（n = 335，116名女性/219名男性，平均年龄43.6±7岁）有16名高血压受试者（4.7%）和3名ACS受试者。ACE - II组（n = 124，45名女性/79名男性，平均年龄42.5±6.9岁）有2名高血压受试者（1.6%）和1名HF受试者。ACE - DD组高血压和心血管事件的发生率（53例，23%）显著高于ACE - ID组和ACE - II组（分别为20例和3例，5.9%和2.4%），P = 0.0001。在年龄较大的组（36 - 45岁和46 - 55岁）中，ACE - DD和ACE - ID基因型的高血压发生率更高。
我们的数据表明，ACE - DD多态性与基线健康受试者中更高的高血压发生率相关，与其他风险因素无关。高血压的较高发生率主要在年龄较大的组中明显。
