UK PROSPECTIVE DIABETES STUDY (UKPDS) .14. ASSOCIATION OF ANGIOTENSIN-CONVERTING ENZYME INSERTION DELETION POLYMORPHISM WITH MYOCARDIAL-INFARCTION IN NIDDM/

The deletion allele of the insertion/deletion polymorphism of the angi otensin-converting enzyme gene has been suggested to be an independent risk factor for myocardial infarction, particularly in subjects judge d to be ''low-risk'' by the criteria of lipid status and body mass ind ex. In a prospective, matched case-control study, we have investigated the role of this polymorphism as a risk factor for myocardial infarct ion in 173 newly-diagnosed British Caucasian non-insulin-dependent dia betic subjects taken from the United Kingdom Prospective Diabetes Stud y who subsequently developed myocardial infarction and 297 control sub jects from the same study population matched for known cardiovascular risk factors including age at diagnosis of diabetes, gender, blood pre ssure, low-density lipoprotein cholesterol, high-density lipoprotein c holesterol, triglyceride and smoking habit. A trend towards increased risk conferred by homozygosity for the deletion allele was observed in cases (odds ratio 1.63, p = 0.09). When the population was stratified according to the matched risk factors, the deletion allele was associ ated with myocardial infarction in those with low plasma low-density l ipoprotein cholesterol (odds ratio 3.67, p = 0.002), or low triglyceri de (odds ratio 3.14, p = 0.005). The strongest association of the dele tion allele with myocardial infarction was observed in subjects with b oth low low-density lipoprotein cholesterol and low triglyceride level s (odds ratio 9.0, p < 0.001). These results show that the deletion al lele is a risk factor for myocardial infarction in non-insulin-depende nt diabetic patients who have a favourable lipid profile.