TIMPs, MMPs and cardiovascular disease.

The matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that cleave the extracellular matrix and have been shown to be regulated by a class of proteins called the tissue inhibitors of metalloproteinases (TIMPs). Several studies have shown that extracellular matrix degradation by MMPs, specifically MMP-9, is involved in the pathogenesis of a wide spectrum of cardiovascular disorders, including atherosclerosis, restenosis, cardiomyopathy, congestive heart failure, myocardial infarction, and aortic aneurysm. This is not surprising since all remodelling, i.e., change in left ventricular geometry and myocardial architecture is associated with a change in the collagen matrix. That both MMPs and TIMPs have recently become fashionable research toys in cardiovascular medicine is documented by the simple fact that a Medline search on June 28, 2004 with the key words ‘‘metalloproteinase’’ and ‘‘cardiovascular’’ revealed 2864 hits, of which more than half (1544) were published within the past five years. Data from the Framingham cohort have challenged the cardiovascular community for more than half a century. The report in the present issue of the Journal is no exception. The authors provide the first communitybased investigation relating plasma TIMP-1 to cardiovascular risk factors and to echocardiographic LV structure and function. Plasma TIMP-1 was directly related to the Framingham Risk Score, and inversely related to LV systolic function. The present paper has to be viewed in light of the recently published data from the same group