PT  - JOURNAL ARTICLE
AU  - Isabel Gonçalves
AU  - Karin Hultman
AU  - Pontus Dunér
AU  - Andreas Edsfeldt
AU  - Bo Hedblad
AU  - Gunilla Nordin Fredrikson
AU  - Harry Björkbacka
AU  - Jan Nilsson
AU  - Eva Bengtsson
TI  - High levels of cathepsin D and cystatin B are associated with increased risk of coronary events
AID  - 10.1136/openhrt-2015-000353
DP  - 2016 Jan 01
TA  - Open Heart
PG  - e000353
VI  - 3
IP  - 1
4099  - http://openheart.bmj.com/content/3/1/e000353.short
4100  - http://openheart.bmj.com/content/3/1/e000353.full
SO  - Open Heart2016 Jan 01; 3
AB  - Objective The majority of acute coronary syndromes are caused by plaque ruptures. Proteases secreted by macrophages play an important role in plaque ruptures by degrading extracellular matrix proteins in the fibrous cap. Matrix metalloproteinases have been shown to be markers for cardiovascular disease whereas the members of the cathepsin protease family are less studied.Methods Cathepsin D, cathepsin L and cystatin B were measured in plasma at baseline from 384 individuals who developed coronary events (CEs), and from 409 age-matched and sex-matched controls from the Malmö Diet and Cancer cardiovascular cohort.Results Cathepsin D (180 (142–238) vs 163 (128–210), p<0.001), cathepsin L (55 (44–73) vs 52 (43–67), p<0.05) and cystatin B levels (45 (36–57) vs 42 (33–52), p<0.001) were significantly increased in CE cases compared to controls. In addition, increased cathepsin D (220 (165–313) vs 167 (133–211), p<0.001), cathepsin L (61 (46–80) vs 53 (43–68), p<0.05) and cystatin B (46 (38–58) vs 43 (34–54), p<0.05) were associated with prevalent diabetes. Furthermore, cathepsin D and cystatin B were increased in smokers. The HRs for incident CE comparing the highest to the lowest tertile(s) of cathepsin D and cystatin B were 1.34 (95% CI 1.02 to 1.75) and 1.26 (95% CI 1.01 to 1.57), respectively, after adjusting for age, sex, low-density lipoprotein/high-density lipoprotein ratio, triglycerides, body mass index, hypertension and glucose, but these associations did not remain significant after further addition of smoking to the model. In addition, cathepsin D was increased in incident CE cases among smokers after adjusting for cardiovascular risk factors.Conclusions The associations of cathepsin D and cystatin B with future CE provide clinical support for a role of these factors in cardiovascular disease, which for cathepsin D may be of particular importance for smokers.