Homozygosity for the deletion allele of the angiotensin-converting enzyme gene (DD) has been associated with a variety of cardiovascular diseases, including ischemic and idiopathic dilated cardiomyopathy, in Caucasians. In this study of 104 Chinese patients with end-stage heart failure due to idiopathic dilated or ischemic cardiomyopathy, the DD genotype frequency was low (12% and 11%, respectively) and was not seen more often than in a control group of 183 subjects without cardiac disease (13%). Therefore, in the Chinese, the DD genotype is less common than in Caucasians and does not appear to be associated with the development of either ischemic or idiopathic dilated cardiomyopathy.