Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
Europace. 2011 Mar;13(3):346-54. doi: 10.1093/europace/euq407. Epub 2010 Nov 13.
Recent observations have raised concerns regarding the activation of the renin-angiotensin system and the development of atrial fibrillation (AF). Some initial studies indicated an association between an angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism and AF, however, the results have been inconsistent. Our aim was to perform a meta-analysis of relevant studies to assess the validity of this association.
PubMed, Cochrane clinical trials database, and EMBASE were searched through July 2009, and a manual search was also performed. Of the 68 initially identified studies, 18 case-control studies with 7577 patients were finally analysed. No statistically significant associations were found between the ACE I/D polymorphism and AF risk in the genetic additive model and dominant model, whereas a significant association was observed in the recessive model. A significant heterogeneity between individual studies was evident in all three models. Subgroup analyses showed a strong association between the ACE I/D polymorphism and hypertensive AF without significant heterogeneity.
Our meta-analysis suggests that there is insufficient evidence to demonstrate an association between ACE I/D polymorphism and AF risk. However, there seems to be a significant association between ACE I/D gene polymorphic variation and AF in patients with hypertension. Additional studies are warranted to further explore this association in ethnically diverse populations and varied cardiovascular substrates.
最近的观察结果引起了人们对肾素-血管紧张素系统激活和心房颤动（AF）发生的关注。一些初步研究表明血管紧张素转换酶插入/缺失（ACE I/D）多态性与 AF 之间存在关联，然而，结果并不一致。我们的目的是对相关研究进行荟萃分析，以评估这种关联的有效性。
通过 2009 年 7 月之前的 PubMed、Cochrane 临床试验数据库和 EMBASE 进行检索，并进行了手工检索。在最初确定的 68 项研究中，最终分析了 18 项病例对照研究，共涉及 7577 例患者。在遗传加性模型和显性模型中，ACE I/D 多态性与 AF 风险之间没有统计学显著关联，而在隐性模型中则存在显著关联。在所有三种模型中，个体研究之间存在显著的异质性。亚组分析显示，ACE I/D 多态性与高血压性 AF 之间存在强烈关联，且异质性不显著。
我们的荟萃分析表明，目前尚无足够证据表明 ACE I/D 多态性与 AF 风险之间存在关联。然而，ACE I/D 基因多态性与高血压患者的 AF 之间似乎存在显著关联。需要进一步的研究来进一步探讨这种在不同种族人群和不同心血管基础中的关联。
