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BACKGROUND: Atherosclerosis is defined as a chronic inflammation of the arterial wall and is the leading cause of cardiovascular disease.Metabolic syndrome is one of the most important risk factors for atherosclerosis.20S proteasome is the active core of ubiquitin-proteasome system.The objective of the present study was to investigate the relationship between coronary artery stenosis degree and 20S proteasome in elderly patients with metabolic syndrome.