Editorials

Angiotensin converting enzyme genotypes and disease

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7008.763 (Published 23 September 1995) Cite this as: BMJ 1995;311:763
  1. Koon K Teo
  1. Associate professor of medicine 2C2 Walter Mackenzie Centre, University of Alberta Hospital, Edmonton, Alberta, Canada T6G 2R7

    Conflicting results from research leave the picture unclear

    Ischaemic heart disease has both environmental and genetic influences, but research has concentrated on the environmental angle. The main modifiable risk factors have been identified and preventive measures introduced with substantial success. Our knowledge of genetic factors has yet to be established in the same ways. The idea of routine tests evaluating genetic risk factors seems appealing but it has not been feasible. Test results could not at present provide a clinician with more than confirmation of a positive family history as an indicator of increased susceptibility to the disease.

    The picture has changed with recent reports that a genotype of the angiotensin converting enzyme (ACE) gene may be a risk factor for ischaemic heart disease.1 2 These studies show the potential of modern molecular biology as a research tool for establishing genetic risk factors for cardiovascular diseases. Moreover, in this case a treatment--angiotensin converting enzyme inhibition--is available and may prove useful for those at risk. As yet, however, the predictive utility of the data from genetic and epidemiological studies remains uncertain.

    A report in Nature by Cambien et al first raised the possibility of an association between ACE gene polymorphism and increased risk for myocardial infarction in relatively homogeneous groups of French and Irish men. This was a retrospective case control comparison of men studied three to nine months after acute myocardial infarction.1 …

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