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Renovascular disease: effect of ACE gene deletion polymorphism and endovascular revascularization

Francesca Pizzolo1, Giancarlo Mansueto, Salvatore Minniti

  • 1Section of Internal Medicine, Department of Clinical and Experimental Medicine, University of Verona, Policlinico Borgo Roma, 37134 Verona, Italy.

Journal of Vascular Surgery
|January 14, 2004
PubMed
Abstract

Insights

Endovascular treatment for renal artery stenosis (RAS) improves survival and renal function compared to conservative therapy. The angiotensin converting enzyme (ACE) DD genotype does not impact RAS patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Genetics

Background:

  • Renal artery stenosis (RAS) significantly increases cardiovascular mortality and causes complications like resistant hypertension and ischemic nephropathy.
  • Current guidelines for endovascular revascularization in RAS remain controversial regarding patient selection and procedural timing.
  • The angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism, specifically the DD genotype, has been linked to RAS prevalence and mortality in prior studies.

Purpose of the Study:

  • To evaluate the long-term impact of endovascular treatment (ET) versus conservative therapy (CT) on mortality, blood pressure control, and renal function in patients with atherosclerotic RAS.
  • To investigate the association between the ACE gene I/D polymorphism (DD genotype) and clinical outcomes in patients with RAS.

Main Methods:

  • Retrospective study of 100 patients with documented atherosclerotic RAS.
  • Evaluation of long-term outcomes (median follow-up: 28 months) including mortality, blood pressure control, and renal function.
  • Comparison of outcomes between patients receiving ET (percutaneous renal transluminal angioplasty or stenting) and those undergoing CT.

Main Results:

  • Patients in the ET group demonstrated significantly higher survival rates (86.7% vs. 67.1%), better blood pressure control (57.4% vs. 29%), and a slower decline in renal function (17.9% vs. 48.4%) compared to the CT group.
  • The DD genotype, present in 50% of patients, showed no significant association with mortality, blood pressure control, renal function decline, or recurrent stenosis rates.
  • Endovascular treatment was associated with improved survival, blood pressure control, and renal function preservation.

Conclusions:

  • Conservative medical management of RAS is linked to worse long-term outcomes, including higher mortality and poorer blood pressure and renal function control, compared to endovascular treatment.
  • Early intervention with endovascular treatment can mitigate the adverse clinical progression of RAS.
  • The ACE DD genotype is not a reliable predictor of clinical outcomes in patients with atherosclerotic renal artery stenosis.

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