Correlation of angiotensin I-converting enzyme gene insertion/deletion polymorphism with rheumatic heart disease: a meta-analysis

Abstract

Rheumatic heart disease (RHD) is a serious cardiovascular disorder worldwide. Several articles have reported the effect of angiotensin I-converting enzyme gene insertion/deletion (ACE I/D) polymorphism in RHD risk. However, the results still remain inconsistent. The objective of the present study was to assess more precise estimations of the relationship between ACE I/D variant and RHD susceptibility. Relevant case–control studies published between January 2000 and 2016 were searched in the electronic databases. The odds ratio (OR) with its 95% confidence interval (CI) was employed to calculate the strength of the effect. A total of nine articles were retrieved, including 1333 RHD patients and 1212 healthy controls. Overall, our result did not detect a significant association between ACE I/D polymorphism and RHD risk under each genetic model (P > 0.05). Subgroup analysis by ethnicity showed no positive relationship in Asians as well (P > 0.05). With respect to the severity of RHD, our result found that the frequency differences between mitral valve lesion (MVL), combined valve lesion (CVL) and healthy controls were not significantly different. Furthermore, no significant association was found between female, male RHD patients and the controls regarding to the ACE I/D polymorphism. In conclusion, our result indicated that ACE I/D polymorphism might not be a risk factor for RHD progression based on the existing research results. Additional well-designed studies with larger samples are still needed to confirm these findings.

Genetic variants in rheumatic fever and rheumatic heart disease

“…The ACE I/D SNP has been significantly associated with serum ACE activity (Zhang et al, ). The ACE gene (I/D) was recently reviewed by Tian et al, consistent with HuGENet™ review study design and recommendations (Tian et al, ). The meta‐analysis, which included the highest number of articles (nine), and a superior number of study participants (1,333 RHD cases and 1,212 controls), showed no association between ACE I/D and the risk of RHD (Tian et al, ).…”

“…The ACE gene (I/D) was recently reviewed by Tian et al, consistent with HuGENet™ review study design and recommendations (Tian et al, ). The meta‐analysis, which included the highest number of articles (nine), and a superior number of study participants (1,333 RHD cases and 1,212 controls), showed no association between ACE I/D and the risk of RHD (Tian et al, ). These results were in contrast with two previous meta‐analyses conducted in RHD cases: a meta‐analysis by Shang et al (), including six studies consisting a total of 981 RHD cases and 901 controls suggested that the ACE I/D SNP was significantly associated with RHD and a meta‐analysis conducted by Gupta et al, , which included four articles constituting 636 RHD cases and 533 controls reported a significant association between the ACE I/D and RHD.…”

“…The remainder of the studies was not subjected to meta‐analysis given recent reviews. For ACE, the most recent pooled analysis, incorporating the largest sample to date, reported no association with RHD (Tian et al, ) whereas the SNP (‐511C>T, rs2853550) variant within Interleukin 1 beta ( IL‐1β ) showed consistent association with RHD (Bhatt et al, ). For the IL‐6 (rs1800795) SNP, results have been unequivocal while no association was found when pooling studies reporting on IL‐10 ‐1082G>A (rs1800896; Bhatt et al, ).…”

The Genetic Control of the Rheumatic Heart: Closing the Genotype-Phenotype Gap

“…The angiotensin I-converting enzyme gene insertion/deletion polymorphism is another example of a locus showing different associations in different populations ( 50 , 51 ). A recent meta-analysis of nine studies including 1333 RHD cases and 1212 controls from seven different populations showed no correlation with the disease or disease subtypes ( 52 ).…”

I/D Polymorphism Gene ACE and Risk of Preeclampsia in Women with Gestational Diabetes Mellitus

“…I/D polymorphism of АСЕ gene is associated with ACE blood level and determines the onset of such diseases as coronary heart disease, left ventricular hypertrophy, arterial hypertension, stroke, diabetic nephropathy, type 2 diabetes mellitus, diabetic nephropathy, diabetic neuropathy, diabetic retinopathy and hypertensive retinopathy, according to different research [ 35 , 38 – 46 ]. ACE gene D-alleles are believed to be a risk factor in these diseases.…”