Influence of Cardiovascular Risk Factors on Levels of Matrix Metalloproteinases 2 and 9 in Human Abdominal Aortic Aneurysms

Objective: To evaluate the influence of cardiovascular risk factors on levels of matrix metalloproteinases (MMP) 2 and 9 in human abdominal aortic aneurysms (AAA). Methods: Aortic samples were collected from patients who underwent AAA repair (n = 89). Patients were stratified according to the maximum transverse aorta diameter: small diameter (<55 mm), moderate diameter (55-69.9 mm) and large diameter (>= 70 mm). Aortic walls were studied using real-time PCR and immunohistochemistry. MMP-2, MMP-9, alpha-actin, CD45, and CD68 transcript levels were determined relative to beta-actin. Quantitative data were expressed as median (IQ-range). Results: No differences were found in MMP-2 expression between the patient groups, which was mainly associated with vascular smooth muscle cells (VSMC); however, MMP-9 displayed the maximum level in the moderate-diameter group, associated with infiltrating macrophages. Current smoking (CS) and renal insufficiency (RI) significantly increased local levels of MMP-2 (CS 349.5 [219.5-414.1] vs. no-CS 184.4 [100.0-320.5]; p<.008; RI 286.8 [189.6-410.8] vs. no-RI 177.3 [99.3-326.9]; p=.047). Nevertheless, after stepwise linear regression analysis only CS remained as an independent variable predicting local levels of MMP-2 (p=.002). No risk factors influenced local levels of MMP-9. Conclusions: The results show that local levels of MMP-2, an important factor for AAA development, were increased in current smoking AAA patients. MMP-2 was mainly associated with VSMC. It is suggested that MMP-2 could contribute significantly to the increased AAA growth rate observed in current smoking patients. These findings support inclusion of smokers in screening for aneurysmal disease, and emphasize the need for more aggressive monitoring of aneurysmal disease outside the surgical range in patients who smoke at the time of diagnosis and in those who continue to smoke during follow-up. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.