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Abouleka Y, Mohammedi K, Carpentier C, Dubois S, Gourdy P, Gautier JF, Roussel R, Scheen A, Alhenc-Gelas F, Hadjadj S, Velho G, Marre M. ACE I/D Polymorphism, Plasma ACE Levels, and Long-term Kidney Outcomes or All-Cause Death in Patients With Type 1 Diabetes. Diabetes Care 2021; 44:1377-1384. [PMID: 33827803 PMCID: PMC8247517 DOI: 10.2337/dc20-3036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The deletion (D) allele of the ACE insertion/deletion (I/D) polymorphism is a risk factor for diabetic kidney disease. We assessed its contribution to long-term kidney outcomes and all-cause death in patients with long-standing type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 1,155 participants from three French and Belgian cohorts were monitored for a median duration of 14 (interquartile range 13) years. The primary outcome was the occurrence of end-stage kidney disease (ESKD) or a 40% drop in the estimated glomerular filtration rate (eGFR). Secondary outcomes were the individual components of the primary outcome, rapid decline in eGFR (steeper than -3 mL/min/1.73 m2 per year), incident albuminuria, all-cause death, and a composite ESKD or all-cause death. Hazard ratios (HRs) for XD versus II genotype and for baseline plasma ACE levels were computed by Cox analysis. Genotype performance in stratifying the primary outcome was tested. RESULTS Genotype distribution was 954 XD and 201 II. The primary outcome occurred in 20% of XD and 13% of II carriers: adjusted HR 2.07 (95% CI 1.32-3.40; P = 0.001). Significant associations were also observed for rapid decline in eGFR, incident albuminuria, ESKD, all-cause death, and ESKD or all-cause death. Baseline plasma ACE levels were higher in XD carriers and significantly associated with an increased risk of the primary outcome. The ACE genotype enhanced net reclassification improvement (0.154, 95% CI 0.007-0.279; P = 0.04) and integrated discrimination improvement (0.012, 95%CI 0.001-0.021; P = 0.02) for primary outcome stratification. CONCLUSIONS The D-allele of the ACE I/D polymorphism was associated with an increased risk of major kidney events and all-cause death in patients with long-standing type 1 diabetes.
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Affiliation(s)
- Yawa Abouleka
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kamel Mohammedi
- Bordeaux University and Hospital, INSERM U1219, Bordeaux, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Pierre Gourdy
- Service d'Endocrinologie Diabétologie Nutrition, CHU de Toulouse, Toulouse, France.,Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPS, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Jean-François Gautier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Alhenc-Gelas
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, Université de Nantes, CHU Nantes, Nantes, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Michel Marre
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France .,Clinique Ambroise Paré, Neuilly-sur-Seine, France
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Marre M. Importance of intensive blood pressure control in type 2 diabetes: Mechanisms, treatments and current guidelines. Diabetes Obes Metab 2020; 22 Suppl 2:33-42. [PMID: 32250521 DOI: 10.1111/dom.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 02/06/2023]
Abstract
Observational and interventional studies have shown that intensified blood pressure (BP) reduction can benefit people with diabetes. Because of their special haemodynamic properties, renin-angiotensin-aldosterone system (RAAS) blockers are recommended. The results of the BP arm of the ADVANCE study strongly support the recently updated European Society of Cardiology/European Association of Diabetes recommendations for the treatment of BP in people with diabetes, which recommend a target systolic/diastolic BP of 130/80 mmHg with few exceptions, and a fixed combination of an RAAS blocker with a diuretic or a calcium channel blocker as first-line treatment.
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Affiliation(s)
- Michel Marre
- INSERM U1138, Centre de Recherches des Cordeliers, Paris, France
- Sorbonne Paris Cité, UFR de Médecine, Université Paris Diderot, Paris, France
- Diabetes Clinic, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
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