Our result was inconformity with two previous meta-analyses: one was conducted by Gupta et al. [32] which only included four relevant articles and less participant (636 RHD cases and 533 controls), indicating that the ACE D allele was significantly associated with increased risk of RHD (P= 0.027); the other was conducted by Shang et al. [38] which contained a total of six articles (981 RHD patients and 901 controls), suggesting that the ACE I/D polymorphism was significantly associated with RHD, and DD genotype increases the risk of RHD (P= 0.04). The gene discussed is ACE; the disease is rheumatic heart disease.