Angiotensin-converting enzyme (ACE) inhibition in type 2, diabetic patients - interaction with ACE insertion/deletion polymorphism
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摘要Angiotensin-converting enzyme (ACE) insertion( I)/deletion ( D) polymorphism may modify the effect of inhibition of the renin - angiotensin - aldosterone system (RAAS) on survival and cardiorenal outcomes in type 2, diabetes. A consecutive cohort of 2089 Chinese type 2 diabetic patients with mean (+/- standard deviation) age of 59.7 +/- 13.1 years were genotyped for this polymorphism by polymerase chain reaction method and were followed prospectively for a median period of 44.6 ( interquartile range: 23.7, 57.5) months. Clinical outcomes, including all-cause mortality, cardiovascular and renal end points, were examined. The frequency for I allele was 67.1 and 32.9% for D allele, with observed genotype frequencies of 45.8, 42.6, and 11.6% for 3, DI and DD, respectively. ACE DD polymorphism was an independent predictor for renal end point with hazard ratio (HR) (95% confidence interval) of 1.72 (1.16, 2.56), but not for cardiovascular end point or mortality. After controlling for confounding factors, including ACE I/D genotype, the usage of RAAS inhibitors was associated with reduced risk of mortality ( HR 0.34 (0.23, 0.50)) and renal end point ( HR 0.55 (0.40, 0.75)). On subgroup analysis, the beneficial effects on survival (II vs DI vs DD: HR 0.29 (0.16, 0.51) vs 0.25 (0.14, 0.46) vs 1.33 (0.41, 4.31)) and renoprotection ( II vs DI vs DD: 0.52 (0.30, 0.90) vs 0.43 ( 0.25, 0.72) vs 0.95 ( 0.43, 2.12)) were most evident in II and DI carriers. In conclusion, inhibition of RAAS was associated with reduced risk of mortality and occurrence of renal end point in Chinese type 2 diabetic patients. These benefits were most evident among II and DI carriers.
著者So WY, Ma RCW, Ozaki R, Tong PCY, Ng MCY, Ho CS, Lam CWK, Chow CC, Chan WB, Kong APS, Chan JCN
期刊名稱Kidney International
出版年份2006
月份4
日期1
卷號69
期次8
出版社NATURE PUBLISHING GROUP
頁次1438 - 1443
國際標準期刊號0085-2538
電子國際標準期刊號1523-1755
語言英式英語
關鍵詞ACE inhibition; ACE polymorphism; Chinese; diabetic nephropathy; type 2 diabetes
Web of Science 學科類別Urology & Nephrology; UROLOGY & NEPHROLOGY

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