Angiotensin I-converting enzyme and plasminogen activator inhibitor-1 genevariants: Risk of mortality and fatal cardiovascular disease in an elderlypopulation-based cohort

OBJECTIVES We studied the contribution of putative risk genotypes at the an giotensin I-converting enzyme inhibitor (ACE D/D) and plasminogen activator inhibitor-1 (PAI-1 4G/4G) loci to all-cause and cardiovascular mortality i n a population-based cohort. BACKGROUND The ACE D/D and PAI-1 4G/4G genotypes have been consistently ass ociated with elevated plasma activities of the gene products. Their role in cardiovascular disease, although explored intensively, is still equivocal. METHODS The ACE and PAI-1 genotypes were determined in 648 subjects greater than or equal to 85 years old. In a cross-sectional analysis, the genotype distributions in a subset of 356 elderly subjects who were born in Leiden, The Netherlands, were compared with those in 250 young subjects whose fami lies originated from the same geographic region. In addition, the complete cohort of elderly subjects was followed over 10 years for all-cause and car diovascular mortality and was stratified according to genotype. RESULTS In the cross-sectional analysis, the ACE and PAI-1 genotype distrib utions were similar in elderly and young subjects. In the prospective follo w-up study, however, the age-adjusted risk of fatal ischemic heart disease was increased threefold (95% confidence interval [CI] 1.2 to 7.6) in elderl y men carrying the PAI-1 4G/4G genotype. The risk of all-cause mortality wa s not increased among elderly subjects carrying the PAI-1 4G/4G (relative r isk [RR] 0.9, 95% CI 0.7 to 1.1) or the ACE D/D genotype (RR 0.9, 95% CI 0. 7 to 1.1), nor did we observe elevated risks of death from all cardiovascul ar diseases combined. There was no interaction between the genotypes. CONCLUSIONS The PAI 4G/4G genotype may be a risk factor for fatal ischemic heart disease in elderly men. The impact of moderately increased ACE and PA I-1 activities associated with the ACE D/D and PAI-1 4G/4G genotypes is too small to affect mortality in the general population. (J Am Coll Cardiol 19 99;34:1176-83) (C) 1999 by the American College of Cardiology.