Original article Insertion/deletion polymorphism of angiotensin I converting enzyme gene and left ventricular hypertrophy in patients with type 2 diabetes mellitus

Abstract

Introduction: Left ventricular hypertrophy (LVH) is a well known risk factor of death from cardiovascular causes. Patients with type 2 diabetes mellitus are at particularly high risk of developing cardiovascular disease, which accounts for 80% of deaths in this group. Type 2 diabetes mellitus is probably related to increased left ventricular mass (LVM). Existing data show that the renin-angiotensin-aldosterone (RAA) system may play a role in the development of LVH. Since the I/D polymorphism of angiotensin-converting enzyme (ACE) gene influences the activity of RAA, it is likely that it could also have an impact on LVH. Aim: To assess the relationship between I/D polymorphism of the ACE gene and the severity of LVH assessed by echocardiography (Echo) in patients with type 2 diabetes mellitus. Methods: The study group consisted of 103 patients (37 women and 66 men; mean age 60.1±9.1 years) suffering from type 2 diabetes mellitus with a mean duration of 9.0±6.5 years. BMI, waist-to-hip ratio (WHR), arterial blood pressure, LVM and LVM index (LVM indexed for body surface area [g/m2] or height raised to the power 2.7 [g/m2.7]) were evaluated. I/D polymorphism of the ACE gene was determined using polymerase chain reaction (PCR). Results: Distribution of I/D polymorphism of the ACE gene in the study group was as follows: genotype II – 32.0%, ID – 42.7%, DD – 25.2% of patients. LVH was diagnosed in 43-71% of patients (depending on criteria used). Distribution of individual genotypes was similar in patients with and without LVH. Genotypes II, ID and DD were observed in 37.3%, 31.4% and 31.4% of patients without LVH (according to the Levy criteria) and in 26.9%, 53.9%, 19.2% in the LVH group, respectively. In persons with DD genotype, when compared to group II, significantly higher values of systolic and diastolic blood pressure were noted (147.7±20.2 vs 138.2±16.7 mmHg, p=0.03 and 89.4±9.7 vs 81.9±8.7 mmHg, p=0.004, respectively). Conclusions: In patients with type 2 diabetes mellitus there is no relationship between I/D polymorphism of the ACE gene and LVH