ANGIOTENSIN-CONVERTING ENZYME GENOTYPE IS NOT ASSOCIATED WITH ENDOTHELIAL DYSFUNCTION IN SUBJECTS WITHOUT OTHER CORONARY RISK-FACTORS

The DD genotype is a polymorphism of the angiotensin-converting enzyme (ACE) gene, and is associated with a significantly increased risk of myocardial infarction. As endothelial dysfunction is an important even t in both early atherogenesis and late atherosclerosis, we hypothesise d that the adverse effect associated with the ACE/DD genotype might be mediated via endothelial damage. Using high resolution ultrasound, we studied the brachial arteries of 184 subjects aged 15-73(mean 38 +/- 14) years, who were all normotensive, non-diabetic lifelong non-smoker s. Arterial diameter was measured at rest, during reactive hyperaemia (with flow increase causing endothelium-dependent dilation) and after sublingual glyceryl trinitrate (GTN, an endothelium-independent vasodi lator). The ACE genotype was determined in each case by DNA amplificat ion; 49/184(27%) had DD, 89(48%) had ID and 46(25%) had II genotype. F low-mediated dilation (FMD) was 8.5% +/- 3.9% in the DD, 7.8% +/- 4.1% in the ID and 7.8% +/- 4.1% in the II subjects (P = NS). GTN-induced dilation was also similar in the 3 groups. On multivariate analysis, e ndothelium-dependent dilation was inversely related to age (r = -0.33, P < 0.001), vessel size (r = -0.41, P < 0.001) but not ACE genotype ( r = 0.002, P = 0.97). The ACE genotype is unrelated to endothelium-dep endent dilation in the systemic arteries of clinically well adults. Th is suggests that the risk associated with this polymorphism may be med iated by other mechanisms.