The Role of Collagen in Coronary Artery Disease

Coronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide, imposing a substantial burden on patients and healthcare systems. Its development and progression are driven not only by lipid accumulation and inflammation but also by extracellular matrix remodeling. Collagen is a core component of the cardiovascular extracellular matrix. Its subtype composition, maturation, cross-linking, synthesis and degradation collectively shape the structural and functional properties of vascular and myocardial tissues. Here, we review collagen biology and use expression profiles from GTEx v11 and Heart Cell Atlas v2 to illustrate tissue- and cell type-specific patterns. These profiles illustrate the expression patterns and major cellular sources of the collagen gene family in the coronary artery and left ventricle. We also evaluate evidence linking collagen-related genetic variation to CAD susceptibility. By connecting genetic variation with protein processing and tissue architecture, this review delineates the potential roles of collagen in plaque stability, coronary thrombosis and post-infarction myocardial remodeling. This framework provides a basis for developing biomarkers of collagen remodeling and mechanism-guided therapeutic strategies.