Elevated matrix metalloproteinase-9 associated with stroke or cardiovascular death in patients with carotid stenosis

Area of Science:

• Cardiovascular Medicine
• Neurology
• Biochemistry

Background:

• Matrix metalloproteinase-9 (MMP-9) is implicated in atherosclerotic plaque destabilization.
• Carotid stenosis poses a significant risk for cerebrovascular events.

Purpose of the Study:

• To investigate the association between plasma MMP-9 levels and the risk of ipsilateral stroke or cardiovascular death in patients with carotid stenosis.
• To evaluate the combined predictive value of MMP-9 and plaque characteristics on cardiovascular outcomes.

Main Methods:

• Prospective follow-up of 207 patients with >= 50% carotid stenosis.
• Measurement of plasma MMP-9 levels and assessment of carotid plaque echogenicity using B-mode ultrasound.
• Analysis of cumulative incidence and hazard ratios for ipsilateral stroke or cardiovascular death.

Main Results:

• Patients with MMP-9 levels above the median (41.9 ng/mL) had a 1.9-fold increased risk of ipsilateral stroke or cardiovascular death (P=0.002).
• This association remained significant up to 10 years of follow-up.
• Elevated MMP-9 combined with echolucent plaques showed a 4.4-fold increased risk for cardiovascular death and a 3.3-fold increased risk for stroke.

Conclusions:

• Elevated plasma MMP-9 is a significant predictor of adverse cardiovascular events in patients with severe carotid stenosis.
• The combination of high MMP-9 and echolucent plaque morphology substantially increases the risk of stroke and cardiovascular death.