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Alves SMM, Alvarado-Arnês LE, Cavalcanti MDGADM, Carrazzone CDFV, Pacheco AGF, Sarteschi C, Moraes MO, de Oliveira WA, Medeiros CDA, Pessoa FG, Mady C, Lannes-Vieira J, Ramires FJA. Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease. Rev Soc Bras Med Trop 2020; 53:e20190488. [PMID: 32638886 PMCID: PMC7341830 DOI: 10.1590/0037-8682-0488-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/20/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.
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Affiliation(s)
- Silvia Marinho Martins Alves
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Biologia das Interações, Rio de Janeiro, RJ, Brasil
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca, Pronto
Socorro Cardiológico de Pernambuco (PROCAPE)/UPE, Recife, PE, Brasil
| | - Lúcia Elena Alvarado-Arnês
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Biologia das Interações, Rio de Janeiro, RJ, Brasil
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Hanseníase, Rio de Janeiro, RJ, Brasil
| | | | | | | | - Camila Sarteschi
- Realcor - Real Hospital Português de Beneficência, Recife, PE,
Brasil
| | - Milton Ozorio Moraes
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Hanseníase, Rio de Janeiro, RJ, Brasil
| | - Wilson Alves de Oliveira
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca, Pronto
Socorro Cardiológico de Pernambuco (PROCAPE)/UPE, Recife, PE, Brasil
| | - Carolina de Araújo Medeiros
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca, Pronto
Socorro Cardiológico de Pernambuco (PROCAPE)/UPE, Recife, PE, Brasil
| | - Fernanda Gallinaro Pessoa
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Charles Mady
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Joseli Lannes-Vieira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de
Biologia das Interações, Rio de Janeiro, RJ, Brasil
| | - Felix José Alvarez Ramires
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP,
Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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