Iwai N, Tamaki S, Ohmichi N, Kinoshita M
First Department of Internal Medicine, Shiga University of Medical Sciences, Japan.
Arterioscler Thromb Vasc Biol. 1997 Sep;17(9):1730-3. doi: 10.1161/01.atv.17.9.1730.
The DD genotype of the angiotensin-converting enzyme (ACE) gene has been reported to be a risk factor for myocardial infarction. However, this association has not been confirmed in some populations. We hypothesized that the discrepancies between these studies may be due to their definition of ischemic heart diseases. According to the genotype of the ACE gene, we analyzed the profiles of 320 patients who underwent coronary angiography for possible ischemic heart diseases. Of these, 23 patients had no significantly diseased vessels and no acetylcholine-induced vasospasm (normal acetylcholine responder [NAR]) (II, 7; ID, 14; DD, 2), 34 patients had no significantly diseased vessels and acetylcholine-induced vasospasm (paradoxical acetylcholine responder: [PAR]) (II, 15; ID, 18; DD, 1), 80 angina pectoris (AP) patients had significantly diseased vessels (II, 41; ID, 37; DD, 2), and 183 patients demonstrated myocardial infarction (MI) (II, 67; ID, 91; DD, 25). The frequency of the DD genotype was significantly lower in PAR and AP patients than in those with MI (P = .0344). Next we analyzed the length of time between the first anginal pain and the onset of myocardial infarction in the MI group. We obtained reliable information regarding this period in 149 of the 183 patients. This period was significantly shorter in the ID and DD groups than in the II group (P = .0022). Multiple regression analyses revealed that this period was significantly determined (P = .0003, R = .324) by the genotype of the ACE gene (II = 1, ID + DD = 2, P = .0003) and age (P = .034). The D allele of the ACE gene and lower age were associated with a shorter period. On the other hand, the genotype of the ACE gene had no significant effect on the number of significantly diseased (> 50%) lesions. The frequency of the D allele in subjects with a rapid progression of MI was significantly higher than that in subjects with a prolonged history of stable AP (P < .0001). In summary, the II genotype of the ACE gene was associated with a longer period of time between the first anginal pain and the onset of myocardial infarction than the ID and DD genotypes of the ACE gene.
血管紧张素转换酶（ACE）基因的DD基因型已被报道为心肌梗死的一个危险因素。然而，这种关联在一些人群中尚未得到证实。我们推测这些研究之间的差异可能是由于它们对缺血性心脏病的定义不同。根据ACE基因的基因型，我们分析了320例因可能患有缺血性心脏病而接受冠状动脉造影的患者的情况。其中，23例患者没有明显病变血管且没有乙酰胆碱诱导的血管痉挛（正常乙酰胆碱反应者[NAR]）（II型，7例；ID型，14例；DD型，2例），34例患者没有明显病变血管但有乙酰胆碱诱导的血管痉挛（矛盾性乙酰胆碱反应者：[PAR]）（II型，15例；ID型，18例；DD型，1例），80例心绞痛（AP）患者有明显病变血管（II型，41例；ID型，37例；DD型，2例），183例患者表现为心肌梗死（MI）（II型，67例；ID型，91例；DD型，25例）。PAR和AP患者中DD基因型的频率显著低于MI患者（P = 0.0344）。接下来，我们分析了MI组中首次心绞痛发作与心肌梗死发病之间的时间长度。在183例患者中的149例中，我们获得了关于这一时期的可靠信息。ID组和DD组的这一时期明显短于II组（P = 0.002）。多元回归分析显示，这一时期由ACE基因的基因型（II = 1，ID + DD = 2，P = 0.0003）和年龄（P = 0.034）显著决定（P = 0.0003，R = 0.324）。ACE基因的D等位基因和较低年龄与较短的时期相关。另一方面，ACE基因的基因型对明显病变（> 50%）病变的数量没有显著影响。MI快速进展患者中D等位基因的频率显著高于稳定AP病史较长的患者（P < 0.0001）。总之，与ACE基因的ID和DD基因型相比，ACE基因的II基因型与首次心绞痛发作与心肌梗死发病之间的时间更长有关。
