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Matrix Metalloproteinases and Cardiac Remodelling in Smokers with Acute Coronary Syndrome

Year: 2026

Type: article

Abstract: Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) regulate extracellular matrix remodeling and contribute to the pathogenesis of coronary artery disease (CAD). This study examined the associations between MMP-2, MMP-9, and TIMP-3 and coronary atherosclerotic burden and cardiac function among smokers and non-smokers across the CAD spectrum. A total of 180 male participants were enrolled and divided into six groups (n = 30 per group): acute coronary syndrome (ACS) smokers, ACS non-smokers, chronic coronary syndrome (CCS) smokers, CCS non-smokers, control smokers, and control non-smokers. Serum MMP-2, MMP-9, and TIMP-3 levels were measured using ELISA. Coronary artery plaque severity was assessed using the Gensini score, while cardiac function was evaluated by echocardiography. MMP-9 and TIMP-3 levels were significantly higher in CCS patients than in controls, regardless of smoking status. MMP-9 showed significant positive correlations with the Gensini score in smokers (r = 0.556, p < 0.001) and non-smokers (r = 0.596, p < 0.001) and remained independently associated with coronary plaque severity in both groups. TIMP-3 was independently associated with the Gensini score only in non-smokers (B = 0.667, p = 0.031). Higher MMP-9 levels were independently associated with reduced left ventricular ejection fraction and adverse diastolic parameters. Overall, MMP-9 was independently associated with coronary atherosclerotic burden and cardiac dysfunction, supporting its potential as a biomarker of CAD severity. ACS, rather than smoking status, appeared to have a greater influence on cardiac dysfunction.

Source: International Journal of Molecular Sciences

DOI: 10.3390/ijms27156970