Department of First Clinical Medical College, Guangxi Medical University, Nanning, Guangxi, China.
Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Medicine (Baltimore). 2023 Mar 10;102(10):e33251. doi: 10.1097/MD.0000000000033251.
Angiotensin-converting enzyme 2, as an internal anti regulator of the renin-angiotensin hormone cascade reaction, plays a protective role in vasodilation, inhibition of fibrosis, and initiation of anti-inflammatory and antioxidative stress by degrading angiotensin II and generating angiotensin (1-7). Multiple studies have shown that plasma angiotensin-converting enzyme 2 activity is low in healthy populations without significant cardiometabolic disease, and elevated plasma angiotensin-converting enzyme 2 levels can be used as a novel biomarker of abnormal myocardial structure and/or adverse events in cardiometabolic diseases. This article aims to elaborate the determinants of plasma angiotensin-converting enzyme 2 concentration, the relevance between angiotensin-converting enzyme 2 and cardiometabolic disease risk markers, and its relative importance compared with known cardiovascular disease risk factors. Confronted with the known cardiovascular risk factors, plasma angiotensin-converting enzyme 2 (ACE2) concentration uniformly emerged as a firm predictor of abnormal myocardial structure and/or adverse events in cardiometabolic diseases and may improve the risk prediction of cardiometabolic diseases when combined with other conventional risk factors. Cardiovascular disease is the leading cause of death worldwide, while the renin-angiotensin system is the main hormone cascade system involved in the pathophysiology of cardiovascular disease. A multi-ancestry global cohort study from the general population by Narula et al revealed that plasma ACE2 concentration was strongly associated with cardiometabolic disease and might be an easily measurable indicator of renin-angiotensin system disorder. The association between this atypical hormone disorder marker and cardiometabolic disease is isolated from conventional cardiac risk factors and brain natriuretic peptide, suggesting that a clearer comprehending of the changes in plasma ACE2 concentration and activity may help us to improve the risk prediction of cardiometabolic disease, guide early diagnosis and feasible therapies, and develop and test new therapeutic targets.
血管紧张素转换酶 2 作为肾素-血管紧张素激素级联反应的内源性抗调节剂，通过降解血管紧张素 II 并生成血管紧张素 (1-7)，在血管扩张、抑制纤维化、启动抗炎和抗氧化应激方面发挥保护作用。多项研究表明，在没有明显心脏代谢疾病的健康人群中，血浆血管紧张素转换酶 2 活性较低，升高的血浆血管紧张素转换酶 2 水平可用作心脏代谢疾病中异常心肌结构和/或不良事件的新型生物标志物。本文旨在阐述血浆血管紧张素转换酶 2 浓度的决定因素、血管紧张素转换酶 2 与心脏代谢疾病风险标志物的相关性及其与已知心血管疾病危险因素的相对重要性。与已知心血管危险因素相比，血浆血管紧张素转换酶 2（ACE2）浓度一致被认为是心脏代谢疾病中异常心肌结构和/或不良事件的可靠预测因子，当与其他常规危险因素结合使用时，可能会改善心脏代谢疾病的风险预测。心血管疾病是全球死亡的主要原因，而肾素-血管紧张素系统是心血管疾病病理生理学的主要激素级联系统。Narula 等人进行的一项来自普通人群的多民族全球队列研究表明，血浆 ACE2 浓度与心脏代谢疾病密切相关，可能是肾素-血管紧张素系统紊乱的一个易于测量的指标。这种非典型激素紊乱标志物与心脏代谢疾病之间的关联与传统心脏危险因素和脑钠肽分离，表明更清楚地了解血浆 ACE2 浓度和活性的变化可能有助于我们改善心脏代谢疾病的风险预测，指导早期诊断和可行的治疗，并开发和测试新的治疗靶点。
