Role of the ACE I/D polymorphism in selected public health-associated sporting modalities: An updated systematic review and meta-analysis

Background: The ACE I/D polymorphism has been suggested to be associated with multiple chronic diseases and sports modalities, which has public health implications for global populations and sport performance. This updated review aims to strengthen the association and identify sporting disciplines that are most influenced by the ACE gene polymorphism using a meta-analysis approach.

Methods: Published studies on the association between the ACE I/D polymorphism and elite endurance and power were collected until 15 June 2024. The studies on public health-associated sports like running, swimming, and cycling were systematically reviewed following pre-agreed criteria, and a meta-analysis was carried out using different genetic models.

Results: A total of 137 studies were identified in the literature search and screened. There was a significant association between elite endurance and the ACE II genotype compared with healthy inactive controls (OR, 1.54; 95%CI, 1.24–1.91) and elite power athletes (OR = 1.56; 95%CI = 1.07–2.28). Specifically, runners and triathletes were associated with the II genotype compared with controls (OR = 1.76; 95%CI = 1.26–2.47; p-value = 0.001 and OR = 2.69; 95%CI = 1.15–6.32, p-value = 0.023, respectively). Additionally, endurance swimmers were associated with the II genotype compared with short-distance, power swimmers (OR = 2.27; 95%CI = 1.49–3.45; p-value < 0.001).

Conclusion: The meta-analysis results confirm and strengthen the association between elite endurance and the ACE I/D polymorphism in different sporting modalities, which may have implications for public health and sports participation.