Of patients with late-onset cardiac hypertrophy, the prevalence of Fabry’s disease has been reported to be as high as 6% in men (mean age 53 years)60 and 12% in women (mean age 50 years).61 A recent study from Spain showed the incidence to be 1% by genotyping (mean age 58 years) (0.9% in men and 1.1% in women), although low alpha-galactosidase activity was present in 3%.62 Strong consideration should be made to check alphagalactosidase A activity in middle-aged patients with hypertrophy in the absence of long-standing hypertension. The gene discussed is GLA; the disease is Fabry disease.