Association between Left Ventricular Hypertrophy (LVH) and Angiotensin Converting Enzyme (ACE) Gene Polymorphism in Diabetic Nephropathy Patients

BACKGROUND: Left ventricular hypertrophy (LVH) is an important risk factor of cardiovascular disease in diabetic nephropathy patients. Renin-angiotensin system has an independent role as a neurohormonal factor in promoting cardiac growth and remodeling. Genetic and environmental factors also influence the pathogenesis of LVH. The association of LVH progression and angiotensin converting enzyme (ACE) gene polymorphism is well known, especially in ACE DD genotype. But there is some controversy between LVH and ACE gene polymorphism. So, we evaluated the prevalence and patterns of LVH and analyzed the associated factors including ACE polymorphism in diabetic nephropathy patients. METHODS: One hundred and eighty one type 2 diabetic patients with overt proteinuria were recruited in the study. ACE genotyping and echocardiogram were performed to observe the association between LVH and ACE polymorphism. RESULTS: The prevalence of LVH was 141 out of 181 (77.9%) patients (concentric, 35.9% and eccentric, 42.0%, each). Patterns of LVH, left ventricular mass (LVM), and left ventricular mass index (LVMI) showed no differences among the three genotypes. But, LVMI was higher in DD genotype group than in II group in men (171.2 vs. 144.8, p=0.028). On the other hand, in women, there were no differences of clinical and echocardiographic variables among three genotypes. LVM and LVMI were negatively correlated with hemoglobin level in all patients. CONCLUSION: The results suggest that ACE DD genotype is associated with LVH in male patients with diabetic nephropathy, but not in female patients. Determining whether or not the gender influences LVH in the diabetic nephropathy patients will require further studies.ope