[Pharmacogenomic control of angiotensin converting enzyme gene I/D polymorphism predominant risk factor of development of chronic heart failure and target of enalapril treatment].

A T Tepliakov, S N Shilov, E N Berezikova, A V Efremov, I D Safronov, M G Pustovetova, S D Maianskaia, Iu Iu Torim, R S Karpov

Index: Kardiologiia 53(3) , 9-14, (2013)

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Abstract

Aim of investigation - to study effect of angiotensin-converting enzyme (ACE) gene polymorphism as a dominant risk factor of development of chronic heart failure (CHF) and target for effective therapy with ACE inhibitor enalapril in patients with ischemic heart disease. We followed 226 patients with CHF on stable permanent basic therapy comprising -adrenoblocker, diuretic, aldosterone antagonist, digoxin, and ACE inhibitor. Seventy eight patients received enalapril (starting dose 2.5 mg twice daily with subsequent titration up to 10-20 mg twice daily). Control group comprised 136 patients without cardiovascular abnormalities. Allele D of polymorphic locus I/D of ACE gene in homozygous state was associated with high risk of development and severity of clinical manifestations of CHF. In patients with D/D genotype of ACE gene at the background of therapy with enelapril we noted more pronounced lowering of CHF functional class and augmentation of left ventricular ejection fraction compared with patients having I/I and I/D genotypes. We revealed associative interrelationships of ACE gene polymorphism (polymorphic locus I/D) with development and severity of CHF as well as effectiveness of therapy with an ACE inhibitor enalapril.