(Circulation. 1995;91:1655-1658.)
© 1995 American Heart Association, Inc.
Articles |
Angiotensin-Converting Enzyme Genotype in Children and Coronary Events in Their Grandparents
From the Department of Cardiovascular Medicine, University of New South Wales/Prince Henry Hospital, Sydney, Australia.
Correspondence to Professor David Wilcken, Department of Cardiovascular Medicine, Clinical Sciences Building, Prince Henry Hospital, Little Bay, NSW 2036, Australia.
Background It has been suggested that the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is an independent risk factor for coronary artery disease. The D/D genotype, which is associated with higher levels of circulating ACE than the I/D or I/I genotype, has been found significantly more frequently in patients with myocardial infarction and also in individuals with a parental history of myocardial infarction.
Methods and Results We explored the distribution of the ACE genotype in 404 school children, aged 6 to 13 years, and related the distribution to the number of their grandparents who had had vascular events. We found a significant association between the number of grandparents who had had coronary events and the ACE genotype (P=.01). In children with two or more grandparents who had had coronary events, there was an excess of both D/D (odds ratio=2.8 [95% confidence interval=1.16-6.56]) and I/D (odds ratio=1.4 [95% confidence interval=0.62-3.25]) genotypes compared with I/I genotypes. In addition, there was an association between the ACE genotype and lipoprotein(a) levels in children (P=.07). Both the ACE genotype and lipoprotein(a) were found to contribute significantly (P=.0042) and independently to family history of coronary artery disease, with the ACE genotype proving to be more predictive than lipoprotein(a) levels.
Conclusions We conclude that the I/D polymorphism of the ACE gene is an important independent risk factor for coronary artery disease and is more predictive that lipoprotein(a). The I/D polymorphism is not only associated with a parental history of myocardial infarction but also with coronary artery disease in second-degree relatives. A further study to explore the relation between the I/D polymorphism and circulating levels of lipoprotein(a) is indicated.
Key Words: angiotensin • enzymes • coronary disease • genes • lipoproteins
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