ACE gene polymorphism and survival in atherosclerotic renovascular disease

Renovascular disease (RVD) is an important cause of end-stage renal disease and is associated with a high mortality rate, mostly because of coexisting cardiovascular and cerebrovascular disease. The deletion (DD) polymorphism of the angiotensin-converting enzyme (ACE) gene has been described in asso ciation with severe vascular disease affecting major organs. To investigate whether DD genotype is a risk factor for mortality in RVD, we performed a follow-up study of 61 patients with this disease. Patients (age, 68.0 +/- 6 .5 years) affected by atherosclerotic vascular disease were enrolled after angiographic demonstration of a renal artery stenosis, The average follow-u p was 48.1 +/- 14.9 months. Genotype was insertion/deletion (IID) in 30 pat ients, DD in 27 patients, and II in 4 patients. At enrollment, a complete a ssessment of heart, blood vessels, and renal function was performed. During the follow-up period, 13 patients died (9 DD, 4 ID) and 7 patients evolved into end-stage renal failure. The cumulative survival rate at 5 years was 45.4% +/- 13.4%. Factors associated with mortality were analyzed with Cox p roportional hazard regression, The multivariate analysis showed that DD gen otype, severe carotid disease, and smoking were independent predictors of m ortality. The multivariate analysis of predictors of renal failure showed t hat the only significant association was found with baseline serum creatini ne level of 265 mu mol/L or greater. We conclude that the DD genotype of th e ACE gene is a marker for mortality in RVD, (C) 2000 by the National Kidne y Foundation, Inc.