GAS pharyngitis is considered to be the primary cause for RHD; however genetic polymorphism among certain molecules such as HLA class II (Human Leukocyte Antigen), TNF (Tumuor Necrosis Factor)-α, IL (InterLeukin)-10, IL-6 and IL-1Ra, ACE (Angiotensin I-converting enzyme) showed an increased risk of RF/RHD5,6,112. The gene discussed is ACE; the disease is rheumatic heart disease.