Angiotensin‐II type 1 receptor gene polymorphism and long‐term survival in patients with idiopathic congestive heart failure

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Abstract
Background: It has been suggested that a genetic polymorphism in the angiotensin II type 1 receptor gene (ATRG) and the ACE gene DD genotype might have a synergistic influence on the risk of developing cardiovascular disease. Aims: To study the possible interaction between polymorphisms in the ACE gene and the ATRG, regarding survival and left ventricular function. Methods: Polymorphism of the two genes was studied in a population‐based cohort of 194 patients with idiopathic heart failure, recruited from the western part of Sweden 1985–1988. The patients were investigated by echocardiography. The survival status was checked during the 7‐year follow‐up period. Results: Although there was no statistically significant additive risk of the ATRG polymorphism, patients carrying the ACE gene DD genotype in combination with a C allele of the ATRG tended to have a poorer prognosis. DD + AA, OR 1.24 (95% CI 0.67–2.32, P = 0.49); DD + AC, OR 1.64 (95% CI 0.95–2.83, P = 0.08); DD + CC, OR 3.54 95% CI 0.78–16.1, P = 0.10); DD + AC/CC, OR 1.84 (95% CI 1.10–3.08, P = 0.02). Patients with the DD + AC/CC genotypes tended to have lower ejection fraction and increased left ventricular mass. Conclusions: There was a trend toward a worse prognosis in patients with the combination of a C‐allele in the ATRG and the ACE gene DD genotype, suggesting an interaction of these two genetic polymorophisms on disease severity.