ASSOCIATION BETWEEN ANGIOTENSIN-I-CONVERTING-ENZYME GENOTYPES, EXTRACRANIAL ARTERY-STENOSIS, AND STROKE

The insertion(I)/deletion(D) polymorphism of the angiotensin-convertin g-enzyme (ACE) gene has been associated with an increased risk of myoc ardial infarction, lacunar stroke, and with an increased intimal-media l thickness in several populations. The aim of this study was to evalu ate whether the ACE I/D genotype is associated with stenosis of extrac ranial arteries and stroke in middle-aged and aged men and women. We s tudied 388 patients (247 male, 141 female) using Doppler and Duplex ul trasound of the extracranial arteries. Patients' history Tvas obtained by standard questionnaire and by the hospital case records. Genomic D NA was analyzed by polymerase chain reaction (PCR) to identify the I/D polymorphism, with a second insertion specific PCR in samples classif ied as homozygous DD genotypes to prevent mistyping. The ACE genotype groups (DD 132, ID 164, II 92) were well matched for the basic charact eristics. The DD genotype was more common in patients with extracrania l artery stenosis greater than or equal to 50% compared with patients without stenosis (59/147 versus 73/241, odds ratio 1.54, 95%-CI 1.01-2 .37), but was not associated with a history of stroke (30/91 versus 10 2/297, odds ratio 0.94, 95%-CI 0.57-1.54). The association of the DD g enotype with extracranial artery stenosis was also present in hyperten sive subjects (n = 206, odds ratio 1.76, 95%-CI 0.99-3.17). In the who le group multiple logistic-regression analysis revealed that the assoc iation of the DD genotype with extracranial artery stenosis was indepe ndent of age, gender, hypertension, hyperlipidemia, and diabetes. In c onclusion, the ACE DD genotype is a weak risk factor for hemodynamical ly relevant stenosis of extracranial arteries, but not for stroke. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.