Limitations of this study
atrophy, sarcopenia, sarcopenic
ATROPHY, SARCOPENIA
This study is limited due to its very small sample size and therefore requires repeating in a larger study. The trial also only recruited individuals with sarcopenia making us reliant on allele frequencies from previous studies rather than a control cohort recruited at the same time and from the same communities. To overcome this latter problem, we identified studies with control cohorts of UK individuals to calculate an allele frequency that was representative of the general UK population. Furthermore, as the group sizes are small and the study was a 2x2 factorial trial it is possible that there was an effect of perindopril on strength in the II/ID group, but this is too small to detect in this study and is complicated either by the treatment with leucine or that inclusion in the trial leads to altered physical activity.In conclusion our analysis suggests that sarcopenic men with the DD ACE genotype may be weaker than men with at least one I allele. We speculate that this is due to differences in the fibre types that have been shown to occur with the differences in genotype and the higher sensitivity of type II fibres to atrophy than type I fibres. The data imply that genotype does not account for the lack of effect of perindopril that we observed in the LACE trial. However, if the basis of the effects of ACE genotype is due to long-term effects of lower ACE levels on fibre type, it is possible that one year of treatment is not sufficient to alter the fibre proportions sufficiently to reduce the loss of strength. It is also possible that the number of type II fibres has been reduced to such an extent that fibre shift is no longer a viable route to increase muscle function.