Atherosclerosis of carotid arteries and the ace insertion/deletion polymorphism in subjects with diabetes mellitus type 2.

4th Department of Internal Medicine, Medical School, University of Crete, Crete, Greece.
International angiology: a journal of the International Union of Angiology (Impact Factor: 1.46). 03/2002; 21(1):63-9.
Source: PubMed

ABSTRACT The aim of the present study was to investigate the association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism with the ultrasonographically evaluated severity and characteristics of carotid artery atherosclerosis in subjects with diabetes mellitus type 2.
We assessed 184 subjects with diabetes mellitus type 2, 75 males and 109 females, mean age 61.4+/-7.7 years. All subjects were receiving oral antidiabetic drugs for glycemic control and were free of cardiovascular events. The ACE genotype was analyzed by the polymerase chain reaction (PCR) technique. The ultrasonographic examination of the carotid arteries was performed in both B-mode imaging and Doppler ultrasound. The common carotid artery intima-media thickness was assessed 15-20 mm proximal to the dilatation of the carotid bulb. The atheromatous lesions were classified according to their echogenic characteristics as predominantly echolucent, mixed and predominantly echogenic with under 30, 30-70 and over 70% of the total plaque area echogenicity, respectively.
From the total cohort 29 (15.8%) subjects had the II, 86 (46.7%) the ID and 69 (37.5%) the DD ACE genotypes. The mean carotid artery diameter stenosis was 37+/-17%, 43+/-19% and 40+/-20% (p=NS) and the intima media thickness was 0.94+/-0.24 mm, 0.97+/-0.20 mm and 0.98+/-0.20 mm (p=NS) in the II, ID and DD subgroups, respectively. When the echogenicity was analyzed according to the ACE I/D polymorphism, 12 subjects (41.4%), 13 (44.8%) and 4 (13.8%) with II genotype had predominantly echogenic, mixed and predominantly echolucent lesions, respectively. The ID genotype diabetics were found to have predominantly echogenic plaques in 41 cases (47.7%), mixed in 30 (34.9%) and predominantly echolucent in 15 cases (17.4%). From the 69 DD subjects 19 (27.5%) had predominantly echogenic plaques, 26 (37.7%) had mixed and 24 (34.8%) had predominantly echolucent lesions. Predominantly echolucent plaques were more frequently encountered among diabetics with the DD genotype (p<0.05), even after correction for demographic characteristics, the main risk factors of atherosclerosis and blood glucose control.
The ACE genotype seems to be associated with the echogenicity of carotid artery atheromatosis but not with the common carotid artery intima media thickness or the degree of internal carotid artery stenosis in subjects with type 2 diabetes mellitus. The DD genotype may be implicated in the increased cardiovascular risk that characterizes echolucent plaques.

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    ABSTRACT: Genetic factors are important in the pathogenesis of coronary artery disease (CAD). The I/D polymorphism in the Angiotensin converting enzyme (ACE) gene is a genetic risk factor for CAD patients who have a history of Myocardial Infraction (MI). We investigated the association between I/D polymorphism of the ACE gene and the presence of CAD in one hundred patients (79 males and 21 females, aged between 21-82) who underwent diagnostic coronary angiography and compared with one hundred patients-as controls (62 males and 38 females, aged between 20-72) who had false symptoms of CAD. The presence of risk factors including age, hypertension, hypercholesterolemia, tobacco use, diabetes mellitus and hyperuricemia was also determined. ACE I/D polymorphism was detected by polymerase chain reaction. The D allele frequency was higher (p <0-01) in CAD patients. The logistic regression analysis indicated that the D allele in association with classical risk factors had the potential to induce CAD, with odds ratio = 0.58(95% CI; 0.37-0.90). This study revealed that, the I/D polymorphism of ACE gene (carrying D allele) was found to be an independent risk factor for CAD in the studied South Indian population. The number of risk factors did not alter the frequency of ACE gene genotype among patients with CAD, however, in normotensives, the odds ratio of DD-genotype was significantly higher, as the D allele of ACE gene polymorphism was found to be associated with morbidity in CAD in this study population.
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    ABSTRACT: Many studies have investigated the association between the angiotensin-coverting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and carotid intima-media thickness (ITM). However, only a few reports so far have studied carotid artery disease by plaque score in non-insulin-dependent diabetes mellitus (NIDDM) patients. To investigate the impact of genetic polymorphisms of the ACE on carotid atherosclerosis in the Slovenian population with NIDDM, we searched for the association between the ACE I/D gene polymorphism and either ITM or plaque score in subjects with NIDDM. Study participants were 292 NIDDM patients, randomly selected from one centre, with diabetes duration ≥ 10 years. The ITM and plaque score of the carotid arteries was determinated by bilateral B-mode ultrasonography. Polymerase chain reaction was used to evaluated the ACE I/D polymorphism. The frequency of the allele D was 55.3 %, and the frequency of the allele I was 44.7 %. The mean ITM was 1.08, 1.09 and 1.07 in the ACE DD, ID, and II genotypes, respectively. The ITM and the prevalence of focal plaque assessed by plaque score were not significantly different among the three genotypes in NIDDM patients. We may conclude that the ACE I/D gene polymorphism is not associated with ITM and plaque score. Therefore it could not be used as a genetic marker of carotid atherosclerosis in NIDDM patients.
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