ABC | Volume 110, Nº1, January 2018

Original Article Fischer et al Gene polymorphisms and coronary disease extension Arq Bras Cardiol. 2018; 110(1):16-23 showed lower levels of nitric oxide and an association with CAD. 40 The variant allele -786T (promoter region) was associated with CAD in a meta-analysis. 41 Genetic score was inversely associated with greater extension and higher severity of CAD. In this population with MS, environmental factors may have an impact on the modulation of the expression of genes related to lipid metabolism, lipoprotein oxidation, endothelial function and blood pressure, and hence on atherogenesis. Conclusion The studied polymorphisms had a small contribution to the extension of CAD. Only LPL D9N polymorphismwas associated with CAD extension in patients with MS and recent ACS. Analysis of combined genetic polymorphisms showed a weak association with CAD extension, and an inverse relationship of genetic score with CAD extension and severity. Study limitations The small sample size and the cross-sectional design may be considered limitations of our study. However, the exploratory aim of the study was to identify genetic polymorphisms that may be used in the identification of more severe atherosclerotic disease in this population of patients with MS and recent ACS. Its results contribute to the selection of genetic polymorphisms to be tested in prospective studies involving larger samples. Author contributions Conception and design of the research: Fischer SCPM, Fonseca FAH, Izar MCO;Acquisition of data: Fischer SCPM, Pinto SP, Lins LCAS, Monteiro CMC, Pinheiro LFM, Izar MCO; Analysis and interpretation of the data and Critical revision of the manuscript for intellectual content: Fischer SCPM, Pinto SP, Lins LCAS, Bianco HT, Monteiro CMC, Pinheiro LFM, Fonseca FAH, Izar MCO; Statistical analysis: Bianco HT, Monteiro CMC, Pinheiro LFM, Fonseca FAH, Izar MCO; Obtaining financing: Izar MCO; Writing of the manuscript: Fischer SCPM, Fonseca FAH, Izar MCO. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by FAPESP, process nº 2004/00325-8. Study Association This article is part of the thesis of master submitted by Simone Cristina Pinto Matheus Fischer, from Universidade Federal de São Paulo. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Universidade Federal de São Paulo (CEP UNIFESP) under the protocol number CEP 0283/11. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 1. WorldHealthOrganization. (WHO). The top ten causes of death. [Accessed in 2017 May 17]. Available from: http://www.who.int/mediacentre/ factsheets/fs310/en/ 2. NgM,FlemingT,RobinsonM,ThomsonB,GraetzN,MargonoC,etal.Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of DiseaseStudy2013.Lancet.2014;384(9945):766-81.doi:10.1016/S0140- 6736(14)60460-8. Erratum in: Lancet. 2014 Aug 30;384(9945):746. 3. ReavenGM.SyndromeX:6years later. J InternMedSuppl.1994;736:13-22. PMID: 7986303. 4. 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