title: Combined renin-angiotensin system gene polymorphisms and outcomes in coronary artery disease - a preliminary report.
abstract: BACKGROUND
  Common variants of the renin-angiotensin system (RAS) genes have been linked to a higher risk of coronary artery disease (CAD) and its complications.
  
  
  OBJECTIVE
  To determine the prognostic significance of a combination of three common polymorphisms of RAS genes (angiotensin converting enzyme - ACE Ins/Del, angiotensin receptor type 1 - AGT1R A1166C and angiotensinogen - ATG M235T) in patients with CAD.
  
  
  METHODS
  The study included 216 patients (mean age 58 ± 9 years, 74% male) prospectively followed for a mean 41 ± 17 months. The end-points were all-cause mortality, myocardial infarction, stroke or the need for coronary revascularisation.
  
  
  RESULTS
  An end-point occurred in 41 (19%) patients. None of the polymorphisms analysed separately was associated with the end-point. Odds ratios were calculated for different combinations of analysed alleles to determine their relation to outcomes. Based on the cut-off points of odds ratios, the study group was divided into three subgroups: 55 patients without ATG 235T allele (T- subgroup); 100 patients with ATG 235T allele alone or ATG 235T allele combined with ACE Del allele or AGT1R 1166C allele (T+ or T+1 subgroup); and 61 patients with all three variants (T+2 subgroup). Multivariate analysis showed that the only independent predictor of the endpoint was an increasing number of variant genes (HR = 2.6, 95% CI 1.4-4.9, p = 0.002).
  
  
  CONCLUSIONS
  Co-existing angiotensinogen M235T AGT polymorphism and two other common polymorphisms of the RAS genes are related to adverse events in patients with CAD.
authors.affiliation: Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. zdziel@wp.pl
authors.forename: Zofia
authors.initials: Z
authors.lastname: Dzielińska
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Małek
authors.forename: Marta
authors.initials: M
authors.lastname: Roszczynko
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Szperl
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Jacek
authors.initials: J
authors.lastname: Kądziela
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zieliński
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications* / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000235:genetics*