ANGIOTENSIN-CONVERTING ENZYME GENE POLYMORPHISM ADDS RISK FOR THE SEVERITY OF CORONARY ATHEROSCLEROSIS IN SMOKERS

To investigate the relation between the angiotensin-converting enzyme (ACE) gene polymorphism and acute coronary syndromes with respect to e nvironmental factors, we analyzed the association of genotype with the coronary angiographic findings of patients with acute myocardial infa rction or unstable angina pectoris, and we examined the linkage of eac h genotype with established risk factors for coronary artery disease. We determined the ACE genotype in 152 Japanese patients with acute cor onary syndromes and 399 healthy individuals. The genotype distribution s were not different between the two groups (P = .74, chi(2) test). In the former group: coronary angiograms were evaluated by criteria base d on the number of diseased vessels, the number of stenotic lesions (g reater than or equal to 50%), and the relative abnormal arterial porti on (extent Index), Although the number of stenotic lesions was higher in patients viith the DD genotype than in those with the ID or II geno type (P = .006), there were no differences in the number of diseased v essels or the extent index. When only smokers were analyzed, the numbe r of diseased vessels (P = .032), number of stenotic lesions (P = .003 ), and extent index (P = .019) were all higher in patients with the DD genotype than in those with the ID or LI genotype. In contrast, these differences in the respective parameters did not exist in nonsmokers. The results indicate smoking-associated effects of the ACE genotype o n the severity of coronary atherosclerosis.