In a multivariate model, male sex, age, ex- and current smoking, heart disease, decreased TIMP-1 and increased MMP-9/TIMP-1 ratio were significantly associated with increased risk for death in non-COPD subjects, while age, current smoking as well as increased MMP-9 and MMP-9/TIMP-1 ratio were associated with increased risk for death among those with COPD (Table 5). This evidence concerns the gene MMP9 and chronic obstructive pulmonary disease.