Atherosclerosis represents a complex, chronic multifactor disease with inflammatory, metabolic and autoimmune components that affects arteries and is characterized by atherosclerotic plaques and phenotypic changes of vascular cells. The members of the matrix metalloproteinase (MMP) family play a crucial role in angiogenesis and vascular remodeling and are involved in the pathogenesis of different vascular diseases such as atherosclerosis, varicose veins, hypertension, abdominal aortic aneurysm, preeclampsia, etc. Alterations in vascular tone are usually a result of changeable endothelial cell function, as well as increasing activity of neurohormonal stimuli or altered sensitivity of vascular smooth muscle. Chronic changes in vascular function lead to structural changes in the blood vessel architecture. The aim of our study was to examine the values of enzymes matrix metalloproteinase-2 and 9 in urine from patients with atherosclerosis of carotid arteries, who underwent surgery, and compared them to controls (healthy volunteers). Patients and methods: we analyzed 40 patients with atherosclerosis who were undergoing the surgical procedure. The study protocols was approved by Ethics Committee of the Medical Faculty, University of Rijeka and written informed consent was obtained for each patient included in the study. Patients’ data and tissue samples were acquired in accordance with the published International Health Guidelines outlined in the declaration of Helsinki. Patients were classified into three groups (patients with symptomatic carotid artery disease, asymptomatic patients in whom surgery is necessary, and blood donors as healthy controls). The method of enzyme immunoassay (ELISA) was used to determine enzymes expression of matrix metalloproteinase-2 and 9 (MMP-2 and 9). Immunohistochemistry, we determined the expression of heat shock protein 70 (HSP 70) on paraffin sections of atherosclerotic carotid arteries. Statistical data were calculated using the computer program Statistica 10.1. Results: The patients with atherosclerosis had a statistically significantly increased level of MMP-2 and 9 in the urine in comparison with healthy volunteers, as well as more intensive expression of heat shock protein 70. Results of MMP 2 and 9 correlated with clinical symptoms. Conclusion: Our data has showed a large increase in the enzyme MMP-2 and 9 in the urine of atherosclerotic patients, which can be an easy and economic marker for the monitoring of the development of atherosclerosis. Upregulation of enzymes MMP 2 and 9 in patients with atherosclerosis underline the crucial role of MMP in pathogenesis of atherosclerosis.