Cardiovascular disease (CVD) is the most common cause of death in industrialized 
countries. One underlying cause is atherosclerosis, which is a systemic disease 
characterized by plaques of retained lipids, inflammatory cells, apoptotic 
cells, calcium and extracellular matrix (ECM) proteins in the arterial wall. The 
biologic composition of an atherosclerotic plaque determines whether the plaque 
is more or less vulnerable, that is prone to rupture or erosion. Here, the ECM 
and tissue repair play an important role in plaque stability, vulnerability and 
progression. This review will focus on ECM remodelling in atherosclerotic 
plaques, with focus on how ECM biomarkers might predict plaque vulnerability and 
outcome.