title: Role of Genetic Polymorphism of Angiotensin-Converting Enzyme, Plasminogen Activator Inhibitor-1 and Endothelial Nitric Oxide Synthase in the Prognosis of Coronary Artery Disease.
abstract: BACKGROUND
  This study was to investigate the effects of multiple genetic polymorphisms and conventional risk factors in the prognosis of coronary artery disease (CAD).
  
  
  METHODS
  One hundred and fifty five patients with CAD were prospectively recruited, they were subgrouped as single vessel disease (SVD) and multiple vessel disease (MVD). All patients were detected I/D polymorphism of angiotensin-converting enzyme (ACE) gene, 4G/5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene, and G894→T mutation of endothelial nitric oxide synthase (eNOS) gene. The patients were followed up for 10-65 months, mean 35 months. End points were major adverse cardiovascular events (MACE), including angina, myocardial infarction, and cardiac sudden death.
  
  
  RESULTS
  During the follow-up period, MACE developed in 81 patients, 73 patients with angina, seven with myocardial infarction, and one with cardiac sudden death. CAD patients with MVD were more probable of developing MACE during follow-up. Distribution of PAI-1 gene polymorphism was significantly different between SVD and MVD patients, p < 0.001. The frequency of DD genotype of ACE and 4G/4G genotype of PAI-1 in patients with MACE were significantly higher than those in patients without MACE, p < 0.001 and p = 0.002, respectively. Incidence of diabetes mellitus was significantly higher in patients with MACE than in patients without MACE, P = 0.03. Cox regression analysis showed that diabetes mellitus (HR 2.36, 95% CI 1.33-4.46, p = 0.003), 4G/4G polymorphism of PAI-1 gene (HR 3.45, 95% CI 1.71-6.56, p = 0.009), and D/D polymorphism of ACE gene (HR 2.99, 95% CI 1.84-5.76, p = 0.005), were independent predictors of the MACE.
  
  
  CONCLUSIONS
  Our results showed that the conventional risk factors and genetic polymorphisms have significant influence on prognosis of CAD patients. CAD patients with diabetes mellitus, DD genotype of ACE, and 4G/4G genotype of PAI-1 suggested poor prognosis.
authors.affiliation: Department of Cardiology, Affiliated Wei Fang People's Hospital of Wei Fang Medical College, Wei Fang, Shandong Province, China.
authors.forename: Ai Yuan
authors.initials: AY
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Affiliated Wei Fang People's Hospital of Wei Fang Medical College, Wei Fang, Shandong Province, China.
authors.forename: Xiang Wu
authors.initials: XW
authors.lastname: Ji
authors.affiliation: Department of Cardiology, Affiliated Wei Fang People's Hospital of Wei Fang Medical College, Wei Fang, Shandong Province, China.
authors.forename: Ai Juan
authors.initials: AJ
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Affiliated Wei Fang People's Hospital of Wei Fang Medical College, Wei Fang, Shandong Province, China.
authors.forename: Li Xue
authors.initials: LX
authors.lastname: Guan
authors.affiliation: Department of Cardiology, Affiliated Wei Fang People's Hospital of Wei Fang Medical College, Wei Fang, Shandong Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Affiliated Wei Fang People's Hospital of Wei Fang Medical College, Wei Fang, Shandong Province, China.
authors.forename: Jing Xian
authors.initials: JX
authors.lastname: Wang
keywords: Angiotensin-converting enzyme; Coronary artery disease; Endothelial nitric oxide synthase; Gene polymorphism; Major adverse cardiovascular event; Plasminogen activator inhibitor-1; Prognosis