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Experimental Diabetes Research
Volume 2012 (2012), Article ID 698695, 7 pages
Research Article

Angiotensin-Converting Enzyme Genotype and Peripheral Arterial Disease in Diabetic Patients

1Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
2Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
3Department of Biological Sciences, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
4Chong's Physical Medicine and Rehabilitation Center, Taipei 116, Taiwan
5Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan 333, Taiwan
6Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung 404, Taiwan

Received 31 May 2011; Revised 16 August 2011; Accepted 5 September 2011

Academic Editor: U. J. Eriksson

Copyright © 2012 Chin-Hsiao Tseng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We investigated the effect of traditional risk factors (hypertension, dyslipidemia and smoking) on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and peripheral arterial disease (PAD) in 945 (454 men and 491 women) Taiwanese type 2 diabetic patients with a mean age of 63.5 (SD: 11.4) years. Among them, 81 (31 men and 50 women) had PAD (ankle-brachial index <0.9). The adjusted odds ratios (95% confidence intervals) were 2.48 (1.18–5.21), 1.69 (1.00–2.85) and 1.64 (1.12–2.39), respectively, for recessive (DD versus II + ID), dominant (DD + ID versus II) and additive (II = 0, ID = 1 and DD = 2) models. While analyzing the interaction between DD and the individual risk factor of hypertension, smoking and dyslipidemia, patients with the risk factor and with DD had the highest risk compared to referent patients without the risk factor and with II/ID. The respective adjusted odds ratios were 5.41 (2.05–14.31), 7.38 (1.87–29.06) and 4.64 (1.70–12.64). We did not find a significant interaction between DD and any of the risk factors under multiplicative or additive scale. In conclusion, traditional risk factors (hypertension, smoking and dyslipidemia) play an important role in the association between ACE genotypes and PAD. Patients with DD genotype and traditional risk factors are at the highest risk.