Serum angiotensin-converting enzyme and recurrent vascular events. The SMART-MR study

• Published in: Atherosclerosis Vol. 224; no. 2; pp. 486 - 491
• Main Authors: Jochemsen, Hadassa M, Geerlings, Mirjam I, Visseren, Frank L, Algra, Ale, van der Graaf, Yolanda, Muller, Majon
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01-10-2012; Elsevier
• Subjects: Aged; angiotensin II; Angiotensin-converting enzyme; angiotensin-converting enzyme inhibitors; atherosclerosis; Atherosclerosis (general aspects, experimental research); Atherosclerosis - blood; Atherosclerosis - diagnosis; Atherosclerosis - enzymology; Atherosclerosis - mortality; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood pressure; blood serum; Brain Ischemia - diagnosis; Brain Ischemia - enzymology; Brain Ischemia - mortality; Cardiology. Vascular system; Cardiovascular; Chi-Square Distribution; chronic exposure; cohort studies; coronary disease; Coronary heart disease; death; drug therapy; Female; Humans; hypertension; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - enzymology; Myocardial Ischemia - mortality; patients; peptidyl-dipeptidase A; Peptidyl-Dipeptidase A - blood; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; risk; Risk Assessment; Risk Factors; screening; Stroke; Stroke - diagnosis; Stroke - enzymology; Stroke - mortality; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Up-Regulation; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Stroke; Blood pressure; Angiotensin-converting enzyme; Coronary heart disease; Nervous system diseases; Cardiovascular disease; Cerebral disorder; Vascular disease; Renin angiotensin system; Central nervous system disease; Angiotensin; Atherosclerosis; Arterial pressure; Hemodynamics; Cerebrovascular disease
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2012.07.010

Abstract Objective Chronic exposure to high levels of angiotensin-converting enzyme (ACE) might increase the risk of hypertensive cardiovascular events. However, little data are available on the association of direct measures of ACE activity with vascular risk and disease. We examined whether serum ACE levels were associated with the risk of recurrent vascular events. Methods Within the SMART-MR study, a prospective cohort study among patients with symptomatic atherosclerotic disease, analyses were performed in 950 patients (mean age 58 ± 10 years) without use of ACE-inhibitors or angiotensin II receptor blockers. At baseline, participants underwent a vascular screening and serum ACE levels (U/L) were measured. Patients were followed for recurrent vascular events, including vascular death, ischemic stroke, and ischemic coronary heart disease (CHD). Results After a mean follow up of 7.2 years (range 0.2–10.1 years), we documented 55 cases of vascular death, 33 cases of ischemic stroke, and 77 cases of ischemic CHD. Multivariable Cox-regression models showed that higher baseline ACE levels were associated with an increased risk of ischemic stroke and CHD; HR's (95%CI) were 1.7 (1.0–2.7) and 1.8 (1.2–2.9). High ACE particularly increased risk of stroke in patients with high blood pressure (defined as >140/90 mmHg) (HR = 4.8; 95%CI 1.0–19.4). This relation was independent of several confounders including use of antihypertensive medication. Serum ACE was not significantly associated with risk of vascular death. Conclusion Our results suggest that in a population with high vascular risk, higher serum ACE levels contribute to an increased risk of ischemic stroke and CHD events.