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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2000;20:281.)
© 2000 American Heart Association, Inc.

Editorials

ACE Gene Polymorphism and Coronary Artery Disease

A Question of Persuasion or Statistical Confusion?

Bernhard Schieffer, MD¹

¹ Helmut Drexler, MD, Department of Cardiology, Medizinische Hochschule Hannover, Hannover, Germany

Correspondence to Bernhard Schieffer, MD, Department of Cardiology, Medizinische Hochschule Hannover, 30625 Hannover, Germany. E-mail Schieffer.Bernhard@MH-Hannover.de

"In the intermediate phase, swiftly developing complexity within the system hides the risk of imminent chaos. But the risk is there." Michael Chrichton’s The Lost World

Great personal enthusiasm, temptation, technical efforts, and complex mathematical equations characterize the developing research field of newly identified gene polymorphisms and their impact on a variety of cardiovascular diseases. After the first publication of Cambien and coworkers¹ in Nature in 1992, who reported that the D/D angiotensin-converting enzyme (ACE) polymorphism is a potent risk factor for myocardial infarction, great enthusiasm emerged that a potentially new class of risk factors was identified. In the following years, researchers repeatedly tried to prove with controversial results that a single-gene polymorphism, such as the ACE polymorphism, is associated with a higher risk of myocardial infarction, for example. Much to their surprise, different populations apparently responded differently with regard to the appearance and overall impact of the ACE polymorphism on myocardial infarction. One of the potential answers is related to the composition of polymorphisms in different study populations. Whereas Cambien et al analyzed a population in which 50% were ACE D/D carriers, the distribution of this polymorphism was found to be only 23% in normal Western populations.

In this issue of Arteriosclerosis, Thrombosis, and Vascular Biology, Agerholm-Larsen and coworkers² report results from a meta-analysis of the ACE gene polymorphism studies with respect to plasma ACE activity, blood pressure, and the risk of myocardial infarction. The authors compared, in their analysis, large-scale studies with smaller . . . [Full Text of this Article]

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