The objective of this study was to test the hypothesis that
apo E (RFLP, HhaI) and/or
angiotensin-converting enzyme (ACE) (ins16del) are associated with higher risk for
coronary heart disease. We investigated 250 patients who underwent complete cardiac examination comprising coronary angioplasty and
biological analysis (CT, HDLc, LDLc, TG,
apo A and
apo B). Prevalence of the alleles of
apo E and ACE was assessed by molecular analysis. Patients without
stenosis or with non-significant
stenosis (> 50% of the vascular lumen) were used as reference group (141 patients). Those presenting a significant
stenosis of the coronary artery (. 50% of the vascular lumen) were considered as cases (109 patients). The relative frequency of the e 4 allele was significantly higher in cases than in reference group (p > 0.02). A strong association have been found between
coronary heart disease and
apo E polymorphism (2 = 8.91; p > 0.05). The presence of the e 4 allele increase the risk of
atherosclerosis (RR = 2.71; IC95%: 1.25-5.90; p > 0.02) compared to e 3 allele. Also, subjects with D allele were more frequent in cases than in reference group (p > 0.001). A significant association was noted between ACE polymorphism and
coronary heart disease (2 = 42.15; p > 0.001). This relationship was positive (rho de Spearman = 0.39; p > 0.01). With
D/D homozygotes patients, the RR for
coronary heart disease was 19.10 (p > 0.001), while The RR with I/D heterozygotes was 6.91 (p > 0.001) compared to I/I homozygotes. A significant interaction have been shown up between
D/D genotype and arterial
hypertension (HTA) (2 de Wald = 16.10; p > 0.001). The multivariate analysis showed that the chronic smoking, diabetes, hypoapolipoproteinemia A, interactive effects between
D/D and HTA, I/D and
obesity, and between
D/D and
hypertriglyceridemia were the major significant factors to take into consideration in our population. We also note that subjects with both D and e 4 alleles were presenting a high risk to
coronary heart disease (RR = 5.93; IC95%: 2.00-17.55; p > 0.01). Thus, those two alleles (4 and D) appears to be important cardiovascular risk factors in the moroccan population.