NEW YORK (Reuters Health) - Polymorphisms in the angiotensin-converting enzyme (ACE) gene may affect the response to spironolactone in patients with chronic heart failure, according to European researchers.
Dr. Mariantonietta Cicoira of Ospedale Civile Maggiore, Verona, Italy and colleagues note that some patients show benefit when the aldosterone antagonist spironolactone is added to ACE inhibitor therapy, while there is no clear effect in others.
To determine whether a genetic mechanism might be involved, the researchers studied 93 patients with chronic heart failure. Their mean age was 62 years and their mean New York Heart Association class was 2.
The report appears in the May 15th issue of the American Journal of Medicine.
Patients were genotyped for insertion (I) and deletion (D) polymorphisms of the ACE gene and randomly assigned to receive spironolactone or to act as controls. The ACE genotype was DD in 26 patients, ID in 51 patients and II in 16 patients.
At 12 months, in the treatment group, only patients not homozygous for the D allele showed a significant improvement in left ventricular ejection fraction, end-systolic volume and end-diastolic volume.
In addition, such changes from baseline between DD and non-DD genotypes were greater within the control group than in the spironolactone group.
Further analysis indicated that although there was some improvement in end-diastolic and end-systolic volume in treated DD patients, compared with non-DD patients, there was a net 1.4% worsening of ejection fraction.
Thus the researchers conclude that the effects of spironolactone “may in part depend on ACE genotype.”
Source: Am J Med 2004;116:657-661. [ Google search on this article ]
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