Related Experiment Video
Updated: May 27, 2026
Subcutaneous Angiotensin II Infusion using Osmotic Pumps Induces Aortic Aneurysms in Mice
Published on: September 28, 2015
Angiotensin-converting enzyme DD polymorphism is associated with poor coronary collateral circulation in patients
Koksal Ceyhan1, Hasan Kadi, Atac Celik
1Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey. kceyhan09@yahoo.com
Insights
The angiotensin-converting enzyme (ACE) DD polymorphism is linked to poor coronary collateral circulation (CCC). Individuals with the D allele may experience endothelial dysfunction and higher ACE levels, impacting cardiovascular health.
Area of Science:
- Cardiovascular Genetics
- Molecular Cardiology
- Genetics of Coronary Artery Disease
Background:
- The association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases is established.
- However, the relationship between ACE I/D polymorphism and coronary collateral circulation (CCC) remains uninvestigated.
Purpose of the Study:
- To explore the potential association between the ACE I/D polymorphism and the development of coronary collateral circulation (CCC).
Main Methods:
- 113 patients with at least one totally occluded coronary artery underwent coronary angiography.
- Coronary collateral circulation was assessed using the Rentrop classification (poor CCC: grades 0-1; good CCC: grades 2-3).
- ACE gene polymorphism was determined using real-time polymerase chain reaction and melting curve analysis.
Main Results:
- The ACE DD genotype and D allele frequency were significantly higher in patients with poor CCC compared to those with good CCC (P < 0.001).
- Plasma ACE levels were also elevated in the poor CCC group (P < 0.001).
- Independent determinants of poor CCC included left circumflex artery occlusion, ACE DD genotype, diabetes, and pulse pressure.
Conclusions:
- The study demonstrates a significant association between the ACE DD polymorphism and poor coronary collateral circulation (CCC).
- Poor CCC in individuals with the D allele may be attributed to endothelial dysfunction and increased plasma ACE levels.
- This finding highlights the genetic influence of ACE I/D polymorphism on collateral development in coronary artery disease.
Objectives:
Although association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases was reported by many studies, the relation between ACE I/D polymorphism and coronary collateral circulation (CCC) has not been studied yet. The aim of the present study was to investigate a possible relationship between ACE I/D polymorphism and CCC.
Methods:
Patients who were subjected to coronary angiography in the 2006 to 2009 period and had at least a completely occluded major artery were included in this study. To classify collateral circulation, we used the Rentrop classification. Patients were classified as having poor CCC (Rentrop grades 0 to 1) or good CCC (Rentrop grades 2 to 3). Gene polymorphism was detected through the detailed melting curve analysis of polymerase chain reaction products after amplification using real-time polymerase chain reaction method and LightCycler 1.5 apparatus.
Results:
We prospectively studied 113 patients who had at least 1 totally occluded major epicardial coronary artery. Forty-seven patients had poor CCC and 67 patients had good CCC. There were no differences among groups in age, sex, risk factors, lipid profile, uses of cardiovascular drugs, and number of diseased vessels. Plasma ACE levels were significantly higher in poor CCC group (P < 0.001). The frequency of DD polymorphism was higher in the poor CCC group (P < 0.001). In allele frequency, we found that the frequency of the D allele was higher in poor CCC group than in the good CCC group (95% confidence interval [CI], 2.16-7.38; P < 0.001). Multiple regression analysis with CCC development as the dependent variable revealed that the presence of total occlusion of the left circumflex artery (95% CI, 1.29-6.6; P = 0.001), ACE DD genotype (95% CI, 2.55-12.79; P = 0.001), presence of diabetes (95% CI, 1.03-3.16; P = 0.005), and pulse pressure (95% CI, 1.04-1.56; P = 0.045) were independent determinants of poor coronary collateral development.
Conclusions:
This study showed that ACE DD polymorphism is associated with poor CCC. Poor collateral circulation in patients carrying the D allele may be associated with endothelial dysfunction and elevated blood ACE levels in these patients.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:11Pharmacogenetics of Drug Targets: β₂-Adrenergic Receptors, Apo E, Thymidylate Synthase
01:30Coronary Artery Disease I: Introduction
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:26Coronary Artery Disease II: Pathophysiology