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Association Between Functional Polymorphisms of Renin-Angiotensin System, Left Ventricular Mass, and Geometry Over 4 Years in a Healthy Chinese Population Aged 60 Years and Older

¹ Division of Cardiology, Department of Internal Medicine, ² Division of Nephrology, Department of Pediatrics, and ³ Department of Family Medicine, Kaohsiung Medical University Hospital, Taiwan.
⁴ Department of Internal Medicine, Faculty of Medicine, Graduate Institute of ⁵ Medicine and ⁶ Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.

Address correspondence to Sheng-Hsiung Sheu, MD, Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University, Chung-Ho Memorial Hospital, 100 Shi-Chuan 1st Road, Kaohsiung. 80708, Taiwan, ROC. E-mail: sheush{at}kmu.edu.tw

Background. Cross-sectional studies investigated the impact of renin-angiotensin system (RAS) gene polymorphism on left ventricular mass index (LVMI) with conflicting results. We conducted a longitudinal study to investigate the influence of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) and angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT1R) A1166C gene polymorphisms on the LVMI and geometry.

Methods. Of 1500 people screened, 110 nondiabetic normotensive elderly Chinese persons were recruited and received echocardiography at baseline and at the 2nd and 4th year follow-up. No participants had a history of organic heart disease or chronic medication. The gene polymorphisms were analyzed by using polymerase chain reaction.

Results. Participant age was 71.9 ± 3.9 years (range 60–81 years). The prevalence of concentric remodeling, eccentric hypertrophy, and concentric hypertrophy was significantly increased as well as LVMI after 4 years (all p <.05). These changes and the magnitude of LVMI increase were significantly higher in participants carrying the ACE D allele than non-D-allele carriers (all p <.05). This association was still significant in multivariate analyses (p .02). A similar analysis showed a borderline significance in the AT1R but not in the AGT gene polymorphism.

Conclusions. This longitudinal study showed that the aging process was associated with an increase of LVMI and changes of geometry. The RAS gene polymorphism, especially the ACE D allele, might modulate these changes in the Chinese population. This provides further knowledge that is essential in the assessment of cardiac disease and the determination of the left ventricular structure in older persons.