Biomarkers of extracellular matrix metabolism (MMP-9 and TIMP-1) and risk of stroke, myocardial infarction and cause-specific mortality : cohort study

Objective: Turnover of the extracellular matrix in all solid organs is governed mainly by a balance between the degrading matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). An altered extracellular matrix metabolism has been implicated in a variety of diseases. We investigated relations of serum levels of MMP-9 and TIMP-1 to mortality risk from an etiological perspective. Design: The prospective Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, followed from 1991–1995 for up to 18.1 years. A random population-based sample of 1,082 71-year-old men, no loss to follow-up. Endpoints were all-cause (n = 628), cardiovascular (n = 230), non-cardiovascular (n = 398) and cancer mortality (n = 178), and fatal or non-fatal myocardial infarction (n = 138) or stroke (n = 163). Results: Serum MMP-9 and TIMP-1 levels were associated with risk of all-cause mortality (Cox proportional hazard ratio [HR] per standard deviation 1.10, 95% confidence interval [CI] 1.03–1.19; and 1.11, 1.02–1.20; respectively). TIMP-1 levels were mainly related to risks of cardiovascular mortality and stroke (HR per standard deviation 1.22, 95% CI 1.09–1.37; and 1.18, 1.04–1.35; respectively). All relations except those of TIMP-1 to stroke risk were attenuated by adjustment for cardiovascular disease risk factors. Relations in a subsample without cardiovascular disease or cancer were similar to those in the total sample. Conclusion: In this community-based cohort of elderly men, serum MMP-9 and TIMP-1 levels were related to mortality risk. An altered extracellular matrix metabolism may be involved in several detrimental pathways, and circulating MMP-9 or TIMP-1 levels may be relevant markers thereof.

The international marketing strategy of grocery retailers – the strategy of adaptation and standardization

Research question – The research question, that this study attempts to answer, is, what and why grocery retailers, which specifically work with the strategy of standardization, adapt in their marketing mix to the host market. Main adaptations are analyzed with regard to psychic distance in terms of consumer characteristics. Methodology – This study presents a qualitative research design. Secondary data, in-depth interviews and personal observations were used, in order to identify adaptations, which were conducted in a grocery retailer in Germany, which is its home market, and in Sweden, which is considered to be a host market. Findings – The main findings of this research indicate that grocery retailers that specifically work with the strategy of standardization, adopt their core strategy at the host market, in order to keep their economy of scale. However, the standardization strategy may cause negative financial results, which is why adaptations, in order to attract new customers, are required. Conclusively, a mix of both, the adaptation and standardization marketing strategy, has to be utilized.