What is the clinical evidence from this study?

Study design: Case-Control. Population: Coronary Artery Spasm (n=150). Intervention: ACE DD genotype vs. ACE ID or II genotype. Primary outcome: Presence of coronary artery spasm (CAS) (OR 15.6, p=0.002).

December 1, 1995Open Access

Angiotensin converting enzyme as a genetic risk factor for coronary artery spasm. Implication in the pathogenesis of myocardial infarction.

YOYuichi OikeGeneral / Preventive / Lipids AHAkira HataCross-Cutting Cardiology YOYuka OgataFukushima Prefectural Culture Center

Key Result

The ACE DD genotype was significantly more frequent in patients with coronary artery spasm compared to those with fixed organic stenosis without spasm (26.2% vs 2.7%, P=0.002).

Study Design

Type

Case-Control (n=150)

Multicenter

Structured PICO

Is the ACE gene DD genotype associated with an increased risk of coronary artery spasm in older Japanese males?

Population

150 Japanese males over 60 years old who underwent coronary angiography for chest pain, evaluated for coronary artery spasm and ACE genotype.

Exposure

ACE gene insertion/deletion (I/D) polymorphism (specifically the DD genotype)

Comparator

Patients without coronary artery spasm (with or without fixed organic stenosis)

Outcome

Presence of coronary artery spasm (CAS) detected using intracoronary injection of ergonovine maleatesurrogate

The ACE gene DD genotype is associated with an increased risk of coronary artery spasm in older Japanese men, suggesting a potential mechanism for its link to myocardial infarction.

Main Result

Odds Ratio: 15.6

Absolute Event Rate: 26.2% vs 2.7%

p-value: p=0.002

Limitations

Association studies can give false positive results.
Sample size was too small to meaningfully evaluate the interaction between ACE and AGT1R genotypes.
Study population was restricted to older Japanese males, limiting generalizability.

Abstract

It has been reported that individuals with the D allele of an insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene are at greater risk for myocardial infarction (MI), especially among subjects normally considered to be at low risk. However, little is known about the mechanism by which the ACE polymorphism affects the risk of MI. Coronary artery spasm (CAS) is considered to be one possible mechanism for developing MI. We therefore examined the ACE polymorphism relation to CAS to determine if this was the mechanism by which the DD genotype influences MI. We studied 150 angiographically assessed Japanese males, all more than 60 yr old. CASs were detected using intracoronary injection of ergonovine maleate. Subjects were divided into three groups: those with CAS (group 1), those without CAS, but with fixed organic stenosis (group 2); and those without CAS and no organic stenosis (group 3). DD subjects were significantly represented in group 1 when compared with groups 2 (P = 0.002) and 3 (P = 0.026). These results suggest that the DD genotype relates to the greater risk for MI in the patients with CAS.

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