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J. Mol. Sci.","IJMS"],"abstract":"<jats:p>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 &lt; 0.001) and non-smokers (r = 0.596, p &lt; 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.<\/jats:p>","DOI":"10.3390\/ijms27156970","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:16:27Z","timestamp":1785766587000},"page":"6970","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Matrix Metalloproteinases and Cardiac Remodelling in Smokers with Acute Coronary Syndrome"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1329-0444","authenticated-orcid":false,"given":"Amilia","family":"Aminuddin","sequence":"first","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0295-2009","authenticated-orcid":false,"given":"Nazirah","family":"Samah","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faridah Mohd","family":"Nor","sequence":"additional","affiliation":[{"name":"Forensic Unit, Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0736-0784","authenticated-orcid":false,"given":"Wan Mohammad Hafiz","family":"Wan Razali","sequence":"additional","affiliation":[{"name":"Forensic Unit, Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"},{"name":"Department of Forensic Pathology, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA, Sungai Buloh 47000, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beh Boon","family":"Cong","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Hospital Canselor Tuanku Muhriz UKM, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawal Faizal","family":"Mohamad","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Hospital Canselor Tuanku Muhriz UKM, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adila A.","family":"Hamid","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafi Khadijah","family":"Norhisham","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8268-3316","authenticated-orcid":false,"given":"Azizah","family":"Ugusman","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","unstructured":"Department of Statistic Malaysia (2026, May 21). 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