# Circulating type I collagen pro-α1 chain is inversely associated with the presence of coronary atherosclerosis in a Swedish middle-aged population

## TL;DR

Low levels of a collagen protein in the blood are linked to more severe coronary artery disease in a middle-aged population.

## Contribution

Shows that circulating COL1α1 is inversely associated with coronary atherosclerosis in a general population.

## Key findings

- Low COL1α1 levels correlate with worse cardiovascular risk profiles.
- COL1α1 is inversely associated with coronary stenosis and non-calcified plaques.
- The association remains significant after adjusting for CAD risk factors.

## Abstract

The turnover of type I collagen plays an important role in atherogenesis and atherothrombosis. The pro-α1(I) chain of type I collagen (COL1α1) has emerged as a novel circulating biomarker associated with coronary artery disease (CAD) events. This study aimed to investigate the association between circulating COL1α1 and coronary atherosclerosis in a middle-aged general population. Participants (n = 1 078) were randomly recruited from the Linköping branch of the Swedish Cardiopulmonary Bioimage Study (SCAPIS) comprising an equal number of men and women 50–64 years old. Coronary artery calcium scores were calculated from non-contrast computed tomography (CT) while coronary stenosis, presence of plaques and segmental involvement scores were derived from coronary CT angiography. COL1α1, interleukin-6 and matrix metalloproteinase-9 were quantified in plasma. Binary logistic regression models were used. Participants with low COL1α1 levels exhibited a more unfavorable cardiovascular risk profile. There was an inverse association between COL1α1 and all measures of coronary atherosclerosis before adjustment (ORrange=0.50–0.73, p < 0.05 for all). In two multivariable models adjusting for potential confounders and CAD risk factors, an association with coronary stenosis ≥ 50% (OR = 0.61 and 0.59, respectively) and non-calcified atherosclerotic plaques (OR = 0.62 for both) remained (p < 0.05 for all). The findings shed further light on COL1α1 as a potential CAD biomarker.

The online version contains supplementary material available at 10.1038/s41598-026-45736-2.