Avtor/Urednik     Černe, Andreja; Kranjec, Igor; Peterlin, Borut
Naslov     Angiotensin-converting enzyme gene polymorphism and acute coronary syndrome
Prevedeni naslov     Polimorfizmi gena za encim angiotenzinsko konvertazo pri bolnikih z akutnim koronarnim sindromom
Tip     članek
Vir     Slov Kardiol
Vol. in št.     Letnik 2, št. 2
Leto izdaje     2005
Obseg     str. 100-4
Jezik     eng
Abstrakt     Objective. Angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism was recently associated with an increased risk for coronary artery disease (CAD), however the precise mechanism of this association remains unknown. Higher level of circulating ACE activity, described in DD genotype carriers may predispose to vascular wall thickening and increased vascular tone. The aims of our study were to assess ACE I/D polymorphism in patients with new onset CAD and to investigate whether ACS I/D polymorphism modulates structural and functional arterial changes in these patients. Methods. One hundred consecutive patients with acute coronary syndrome (ACS) as a first clinical manifestation of obstructive CAD and 80 healthy subjects underwent ACE I/D genotyping by polymerase chain reaction. The carotid intima-media thickness (IMT) and brachial endothelium-dependent (flow-mediated) as well as endothelium-independent (glyceryltrinitrate-induced) dilation were measured by the echo Doppler technique. Results. The ACE DD genotype occurred more frequently in ACS patients than in controls (37% vs. 21%; p<0.05). By multivariate regression analysis adjusting for traditional CAD predictors, the ACE DD genotype conferred a 2.4-fold increased risk for ACS (95% CI 1.1-6.6; p<0.05). In ACS patients, the DD genotype was associated with a significantly increased carotid IMT (DD vs. II; 0.94+-0.20 mm vs. 0.79+-0.20 mm; p<0.05) and impaired brachial endothelium-dependent dilation (DD vs. II; 5.9+-4.2% vs. 8.7+-2.9%, p<0.05). Conclusion. ACE I/D polymorphism emerged as an independent risk factor for ACS in our study population. A positive association between the ACE DD genotype and early structural and functional arterial changes was detected, suggesting a possible pathogenetic link between the ACE polymorphism and the underlying disease.
Izvleček     Namen. Polimorfizem insercije in delecije (I/D) angiotenzinske konvertaze (ACE) so nedavno povezali z zvečanim tveganjem za koronarno bolezen, vendar ostaja natančen mehanizem te povezave neznan. Zvišana aktivnost ACE v krvi nosilcev genotipa DD naj bi povzročala zadebelitev žine stene in povečanje žilnega tonusa. Z našo raziskavo smo želeli oceniti polimorfizem I/D ACE pri bolnikih z novoodkrito koronarno boleznijo ter preučiti, ali je polimorfizem I/D povezan s spremembami v strukturi in delovanju arterijskega žilja prizadetih bolnikov. Metode. Sto zaporednim bolnikom z akutnim koronarnim sindromom (AKS) in poprej neznano koronarnim obolenjem ter 80 zdravim preiskovancem smo določili genotip ACE I/D s pomočjo verižne reakcije s polimerazo. Z doplersko ultrazvočno preiskavo smo ocenitili debelino intime-medije ter določili od endotelija odvisno (sproženo s pretokom) in od endotelija neodvisno (sproženo z nitroglicerinom) vazodilatacijo brahialne arterije. Izsledki. Genotip ACE DD smo pogosteje zasledili pri bolnikih z AKS v primerjavi z zdravimi preiskovanci (37% proti 21%; p < 0,05). Z multivariatno metodo, ki je izključila zavajajoč vpliv klasičnih dejavnikov tveganja za koronarno bolezen, smo potrdili, da je genotip DD povezan z 2,4-kratnim tveganjem za AKS (95-odstotni razpon zaupanja 1,1-6,6; p < 0,05). Pri bolnikihz AKS smo zasledili povezavo med zadebeljeno intimo-medijo (0,94±0,20 mm pri DD proti. 0,79±0,20 mm; p< 0,05 pri II) in okrnjeno vazodilatacijo (5,9±4,2% pri DD proti 8,7±2,9 % pri II; p < 0,05). Zaključki. Pri naši skupini preiskovancev smo polimorfizem I/D ACE opredelili kot neodvisni dejavnik tveganja za AKS. Potrdili smo pozitivno povezanost med genotipom DD ACE in zgodnjimi spremembami v strukturi in delovanju arterijskega žilja, kar nakazuje patogenetsko povezavo med polimorfizmom ACE in aterosklerotičnim obolenji.
Deskriptorji     PEPTIDYL-DIPEPTIDASE A
CORONARY DISEASE
POLYMORPHISM (GENETICS)
GENOTYPE
BRACHIAL ARTERY
POLYMERASE CHAIN REACTION
NITROGLYCERIN
VASODILATION
MYOCARDIAL INFARCTION
ANGINA, UNSTABLE
TUNICA INTIMA
TUNICA MEDIA
HYPERTENSION
SMOKING
HYPERCHOLESTEROLEMIA