Introduction: This study was performed to clarify the effects of angiotensin converting enzyme (ACE) I/D polymorphism on the risk of insulin resistance and polycystic ovary syndrome (PCOS).
Methods: Six genotype models and the mean difference (MD)/standardized mean difference (SMD) were applied to evaluate the effects of ACE I/D polymorphism on insulin resistance and PCOS risk.
Results: Thirteen studies with 3212 PCOS patients and 2314 controls were collected. In the pooled analysis and Caucasian subgroup, the ACE I/D polymorphism was significantly associated with PCOS risk, even after removing the non-Hardy-Weinberg equilibrium (HWE) studies. Moreover, the positive effect of ACE I/D polymorphism in PCOS was mainly presented in Caucasians (removing non-HWE, DD + DI vs II: OR=2.15, P=0.017; DD vs DI + II: OR=2.64, P=0.007; DD vs DI: OR=2.48, P=0.014; DD vs II: OR=3.31, P=0.005; D vs I: OR=2.02, P=0.005) compared to Asians. Interestingly, only in the Asians was the ACE I/D polymorphism significantly correlated to insulin levels (DI vs II: SMD=0.19, 95%CI= (0.03, 0.35), P=0.023) and HOMA-IR (DI vs II: MD=0.50, 95%CI= (0.05, 0.95), P=0.031).
Conclusions: The D allele of the ACE I/D polymorphism promotes PCOS development. Moreover, the ACE I/D polymorphism was also associated with insulin-resistant PCOS, especially among Asians.