The Association of Angiotensin Converting Enzyme and Angiotensinogen Gene Polymorphism With Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis

Background: Limited evidence exists for an association between dilated cardiomyopathy (DCM) and the angiotensin-converting enzyme (ACE) gene with an insertion/deletion (I/D) angiotensinogen (AGT) M235T gene polymorphism. A systematic review and meta-analysis were conducted to elucidate the role of ACE I/D and AGT M235T in the morbidity of DCM. This meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines for Abstracts. Methods: The PubMed, Embase, and Cochrane Library databases, as well as the Chinese Biomedical Literature Database, were reviewed to identify and collect all relevant studies. The association between ACE I/D, AGT M235T gene polymorphism, and DCM was estimated by pooling the odds ratio (OR) using the RevMan5.4.1 and Stata12.0 software. Results: A total of 27 eligible studies that explored the ACE I/D gene polymorphism in a healthy control group and the DCM patients were included in the present meta-analysis. A recessive genetic model was presented in the ACE I/D genotype. The pooled OR (DD vs. DI+II) following recessive genetic modelling was 1.37 (95% confidence interval (CI): 1.13, 1.66; p < 0.01). DCM patients tend to carry the DD genotype, indicating that the ACE I/D gene polymorphism might be associated with DCM. Similarly, seven studies were analyzed that presented a correlation between AGT M235T polymorphism and DCM morbidity. The OR (MT + TT vs. MM) value, according to a dominant genetic model, was 1.83 (95% CI: 0.90, 3.73; p > 0.05). Conclusion: The AGT M235T polymorphism was not significantly associated with DCM; however, the ACE I/D polymorphism was related to a risk of DCM.