INSERTION DELETION POLYMORPHISM IN THE ANGIOTENSIN-CONVERTING ENZYME GENE ASSOCIATED WITH MACROANGIOPATHY AND BLOOD-PRESSURE IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS

In the search for new risk factors for diabetic macroangiopathy the in sertion/deletion (I/D) polymorphism in the angiotensin-converting enzy me gene was studied in 237 consecutive patients (125 men and 112 women ) with non-insulin-dependent diabetes. The female population showed an excess of ischemic electrocardiographic changes or definite myocardia l infarctions in the patients homozygous for the deletion [D/D; odds r atio (OR) 2.8; 95% confidence interval. (CI) 1.4-5.3] and in the inser tion/deletion heterozygotes (I/D; OR 1.8; CI 1.1-3.1) compared with th e patients homozygous for the insertion (YI). In the total series coro nary heart disease, cerebrovascular disease, and claudication were mor e often observed in the patients with I/D (OR 1.5; CI 1.0-2.2) or the D/D genotype patients (OR 1.7; CI 1.1-2.6) than in those with the geno type I/I. The systolic blood pressure was lower in patients with genot ype I/I (138+/-19 mmHg) than in those with the genotype I/D (149+/-22 mmHg) or D/D (150+/-21 mmHg; P<0.02). The prevalence of hypertension a nd the median urinary albumin excretion rate also tended to be lowest in the I/I genotype patients. Multiple logistic analysis revealed that in women the angiotensin-converting enzyme D/D genotype is independen tly associated with coronary heart disease. Our findings suggest that variation at the angiotensin-converting enzyme gene locus is one of th e factors involved in the predisposition of diabetic patients to the d evelopment of arterial disease and hypertension.