he vascular endothelium plays an important role in the regulation of vascular tone and the maintenance of cardiovascular homeostasis. 1 Importantly, endothelial dysfunction, particularly impaired endotheliumdependent vasodilation, has been linked to the pathogenesis of atherosclerotic vascular disease and acute cardiovascular events. 2 Indeed, reduced endothelial vasodilatory function occurs early in atherogenesis before histological and angiographic evidence. 3,4 Epidemiologic studies have shown that high levels of physical activity and cardiorespiratory fitness reduce cardiovascular morbidity and mortality in the general population, including healthy subjects. 5,6 It is clinically important to select the appropriate kind of exercise. Regular aerobic exercise is associated with beneficial changes in blood pressure, lipid metabolism, glucose metabolism, neurohormonal factors, body weight, and shear stress. 7,8 Although the mechanism of improvement in endothelial function during exercise has not been fully clarified, it is thought that nitric oxide (NO) production is increased by up-regulation of endothelial NO synthase gene expression and vascular endothelial growth factor-induced angiogenesis, as well as decreased NO inactivation with augmented antioxidants, Circulation Journal Vol. 69, September 2005 such as superoxide dismutase and glutathione peroxidase, and attenuation of nicotinamide adenine dinucleotide/nicotinamide adenine dinucleotide phosphate (NADH/NADPH) oxidase activity, all leading to an increase in NO bioavailability. 9 Polymorphisms of the angiotensin converting enzyme (ACE) gene, located on chromosome 17, have been found and the polymorphism is characterized by the presence (insertion (I)) or absence (deletion (D)) of a 287-base-pair alu repeat within intron 16. The presence of the D allele has been associated with higher concentrations of circulating and tissue ACE. Increased ACE activity might lead to high Angiotensin II (Ang II) concentrations. 10 Of the several candidate genes for endothelial dysfunction, the ACE gene appears to be a likely one because (1) it is anchored via its carboxyl terminus to the endoluminal side of the endothelial cell plasma membrane, from where it can be released in the bloodstream, 11,12 and (2) the increased plasma ACE activity found in subjects with the D allele could decrease bradykinin bioactivity with ensuing blunting of receptormediated release of NO. 13 Furthermore, even though the literature is variable on whether Ang II effects are increased in subjects with the D allele, 14,15 enhanced Ang II production can increase the concentrations of superoxide through increased activity of NADH/NADPH oxidase activity 16 and thus lower the bioactivity of NO. 17 The balance of vasodilators and vasoconstrictors also plays an important role in the physiologic regulation of vascular tone; 18 However, it is not clear whether the ACE genotype can modify the endothelial response to exercise in athletes.The aim of this study was to investigate the relationship between the...