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Circulation. 2004;109:1640-1646
Published online before print March 15, 2004, doi: 10.1161/01.CIR.0000124487.36586.26
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(Circulation. 2004;109:1640-1646.)
© 2004 American Heart Association, Inc.


Clinical Investigation and Reports

Renin-Angiotensin System Gene Polymorphisms and Atrial Fibrillation

Chia-Ti Tsai, MD; Ling-Ping Lai, MD, PhD; Jiunn-Lee Lin, MD, PhD; Fu-Tien Chiang, MD, PhD; Juey-Jen Hwang, MD, PhD; Marylyn D. Ritchie, MS; Jason H. Moore, PhD; Kuan-Lih Hsu, MD, PhD; Chuen-Den Tseng, MD, PhD; Chiau-Suong Liau, MD; Yung-Zu Tseng, MD

From the Division of Cardiology, Department of Internal Medicine (C.-T.T., L.-P.L., J.-L.L., F.-T.C., J.-J.H., K.-L.H., C.-D.T., C.-S.L., Y.-Z.T.) and Department of Laboratory Medicine (F.-T.C.), National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine (C.-T.T.), Yunlin Hospital, Department of Health, Executive Yuan, Yulin, Taiwan; and Program in Human Genetics and Department of Molecular Physiology and Biophysics (M.D.R., J.H.M.), Vanderbilt University Medical School, Nashville, Tenn.

Correspondence to Fu-Tien Chiang, MD, PhD, Professor, Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei 100, Taiwan. E-mail futienc{at}ha.mc.ntu.edu.tw

Received July 16, 2002; de novo received August 15, 2003; revision received December 29, 2003; accepted January 14, 2004.

Background— The activated local atrial renin-angiotensin system (RAS) has been reported to play an important role in the pathogenesis of atrial fibrillation (AF). We hypothesized that RAS genes might be among the susceptibility genes of nonfamilial structural AF and conducted a genetic case-control study to demonstrate this.

Methods and Results— A total of 250 patients with documented nonfamilial structural AF and 250 controls were selected. The controls were matched to cases on a 1-to-1 basis with regard to age, gender, presence of left ventricular dysfunction, and presence of significant valvular heart disease. The ACE gene insertion/deletion polymorphism, the T174M, M235T, G-6A, A-20C, G-152A, and G-217A polymorphisms of the angiotensinogen gene, and the A1166C polymorphism of the angiotensin II type I receptor gene were genotyped. In multilocus haplotype analysis, the angiotensinogen gene haplotype profile was significantly different between cases and controls ({chi}2=62.5, P=0.0002). In single-locus analysis, M235T, G-6A, and G-217A were significantly associated with AF. Frequencies of the M235, G-6, and G-217 alleles were significantly higher in cases than in controls (P=0.000, 0.005, and 0.002, respectively). The odds ratios for AF were 2.5 (95% CI 1.7 to 3.3) with M235/M235 plus M235/T235 genotype, 3.3 (95% CI 1.3 to 10.0) with G-6/G-6 genotype, and 2.0 (95% CI 1.3 to 2.5) with G-217/G-217 genotype. Furthermore, significant gene-gene interactions were detected by the multifactor-dimensionality reduction method and multilocus linkage disequilibrium tests.

Conclusions— This study demonstrates the association of RAS gene polymorphisms with nonfamilial structural AF and may provide the rationale for clinical trials to investigate the use of ACE inhibitor or angiotensin II antagonist in the treatment of structural AF.


Key Words: arrhythmia • genetics • fibrillation • renin • angiotensin




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