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Is ACE level rather than ACE genotype a risk factor for cardiovascular disease?
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Pharmacology .
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiology .
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-9095-403X
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Polymorphism in the angiotensin-converting enzyme gene (ACE I/D polymorphism) is associated with the level of ACE in plasma. However, there are large variations in plasma ACE level among individuals with the same genotype. Furthermore, ACE D/D genotype has been associated with increased risk for cardiovascular disease. The aim of this study was to investigate variations in plasma ACE levels in order to elucidate the associations between circulating ACE levels, ACE genotype, known cardiovascular risk factors and cardiovascular diseases (CVDs).

Methods and Results: Plasma ACE levels and ACE genotype were analysed in a Swedish population consisting of 672 elderly men and women. Association between ACE-genotype, levels of circulating ACE and known cardiovascular risk factors and CVDs were analyzed. The results showed increased plasma ACE levels in individuals with hypertension (p=0.003), ischemic heart disease (p=0.03), in smokers (p=0.011) and in individuals with heredity for CVDs (p=0.031). Furthermore, treatment with ACE inhibitors increased the level of ACE in plasma (p<0.001). No association was found between D/D genotype and CVD. Instead, ischemic heart disease was more frequent among carriers of the I/I genotype (p=0.009).

Conclusion: Although plasma ACE levels are strongly influenced by ACE genotype, there are large variations in plasma ACE level among carriers of the same genotype. Our data does not support an association between ACE D/D polymorphism and CVDs but indicates an association to increased level of ACE in the circulation, suggesting that ACE level rather than ACE genotype is the crucial factor associated with risk for CVDs.

Keyword [en]
Atherosclerosis, endothelium, genetics, hypertension, smoking
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16703OAI: oai:DiVA.org:liu-16703DiVA: diva2:160222
Available from: 2009-02-12 Created: 2009-02-12 Last updated: 2017-03-27Bibliographically approved
In thesis
1. Angiotensin-Converting Enzyme: Effects of Smoking and Other Risk Factors for Cardiovascular Diseases
Open this publication in new window or tab >>Angiotensin-Converting Enzyme: Effects of Smoking and Other Risk Factors for Cardiovascular Diseases
2009 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiovascular diseases (CVDs) are the most common cause of death in Western countries. Smoking, hypertension, diabetes mellitus and hypercholesterolemia are considered as major risk factors. However, the underlying mechanisms by which these factors cause CVDs are not entirely clear. Angiotensin-converting enzyme (ACE) is a key enzyme in the renin-angiotensin-aldosterone system, converting angiotensin I to the vasoactive peptide angiotensin II. Besides being an important factor for normal regulation of blood pressure, ACE appears to be involved in the pathogenesis of atherosclerosis. Previous studies have shown an upregulation of ACE in atherosclerotic plaques. There is genetic polymorphism in the ACE gene (ACE I/D polymorphism) which is strongly connected to the levels of ACE in plasma, but has also been associated with higher risk for cardiovascular diseases. The aim of this thesis was to investigate ACE in vitro and in vivo, in relation to cardiovascular risk factors and CVDs. The results showed that nicotine and nicotine metabolites increase ACE activity in human endothelial cells in vitro. Smoking was associated with increased plasma ACE levels. This effect might be mediated by nicotine and nicotine metabolites. These results could explain one cellular mechanism by which smoking exerts negative effect on the vascular system. Extract of oral snuff inhibited ACE in human endothelial cells and in serum, whereas extract of cigarette smoke had no effect on endothelial ACE. If these results have any physiological relevance remains to be investigated. Cardiovascular risk factors and CVDs were associated with increased levels of ACE in plasma. No association between ACE D/D genotype and CVDs was found. Based on these results we suggest that an increased level of ACE, rather than ACE genotype, is associated with increased risk for CVDs.

Abstract [sv]

Hjärtkärlsjukdomar är den vanligaste dödsorsaken i industriländer. Åderförkalkning är den bakomliggande process som orsakar hjärtkärlsjukdomar. En mängd olika riskfaktorer har identifierats (rökning, högt blodtryck, diabetes etc.) men man har inte helt lyckats kartlägga mekanismerna för hur dessa riskfaktorer leder till förkalkning av kärlen. Renin-angiotensin-aldosteron-systemet är ett av de viktigaste systemen i kroppen vad gäller reglering av blodtryck och vätske- och saltbalans. Angiotensin-converting enzyme (ACE) är ett nyckelenzym i reninangiotensin-aldosteron systemet och omvandlar angiotensin I till den aktiva peptiden angiotensin II. ACE är en central parameter för normal reglering av blodtryck, men man tror även att det är en viktig faktor för uppkomst av åderförkalkning. Tidigare studier har visat att individer med åderförkalkning har en ökad mängd ACE i det förkalkade området. Det finns en genetisk variation i genen för ACE som är starkt kopplad till mängd ACE i blodet. Ett antal studier har visat ett samband mellan denna genvariation och risken att drabbas av hjärtkärlsjukdomar, medan andra studier inte funnit detta samband. Syftet med denna avhandling var att undersöka ACE i relation till risk faktorer för hjärtkärlsjukdomar och förekomst av hjärtkärlsjukdomar. Resultaten visar att nikotin och levernedbrytningsprodukter av nikotin (nikotinmetaboliter) ökar aktiviteten av ACE i mänskliga endotelceller, den celltyp som täcker insidan av alla blodkärl. Dessutom visades att rökning resulterar i en ökad mängd ACE i blodet. Det är tänkbart att denna effekt orsakas av nikotin och nikotinmetaboliter och skulle kunna vara en mekanism för hur rökning ger upphov till hjärtkärlsjukdomar. Snus däremot minskade aktiviteten av ACE, medan cigarrettrök inte hade någon effekt. Dessutom visades att både riskfaktorer för hjärtkärlsjukdomar och förekomst av hjärtkärlsjukdomar resulterar i en ökad mängd ACE i blodet och vi föreslår att mängden ACE är en viktigare faktor än ACE-genvariant, vad gäller risken för att drabbas av hjärtkärlsjukdom.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 67 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 92
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-16704 (URN)978-91-7393-712-2 (ISBN)
Presentation
2009-03-09, Linden, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Supervisors
Available from: 2009-02-12 Created: 2009-02-12 Last updated: 2013-07-04Bibliographically approved

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Ljungberg, LizaAlehagen, UrbanBjörck, HannaToste, LänneDahlström, UlfPersson, Karin

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