Abstract-Cathepsin G (CTSG), a serine protease released from activated neutrophils, may cause platelet activation, leading to intravascular thrombosis, thus contributing to cardiovascular and cerebrovascular disease. Applying the candidate gene approach, we screened the 5Ј-flanking region and the entire coding region of the CTSG gene for genetic variation by using polymerase chain reaction/single-strand conformation polymorphism analysis from 96 patients at high risk for myocardial infarction (MI). We identified 4 polymorphisms in the 5Ј-flanking region (G-618C, G-315A, C-179T, and C-160T) and 1 polymorphism in the coding region (Asn125Ser) of the gene and genotyped the participants in the Etude Cas-Temoins sur l'Infarctus du Myocarde (ECTIM Study), a case-control study for MI, and in the Étude du Profil Génétique de l'Infarctus Cérébral (GENIC Study), a case-control study for brain infarction (BI), for all identified genetic variants. The potential in vitro functionality of the 4 variants in the 5Ј-flanking region was investigated with transient transfection analyses in U937 cells with different allelic promoter constructs by using a luciferase assay. Our in vitro analyses did not reveal any differences for the investigated allelic constructs with respect to promoter activity, and none of the polymorphisms in the 5Ј-flanking region was associated with the available phenotypes in either study. Allele and genotype distributions of all identified polymorphisms did not globally differ between cases and controls in the ECTIM Study. However, in patients from the ECTIM Study, the Ser125 allele was significantly associated with elevated plasma fibrinogen levels (Pϭ0.006), but this effect was not seen in controls (case-control heterogeneity, Pϭ0.04). There was a significant interaction between CTSG Asn125Ser and the -fibrinogen gene polymorphism G-455A on plasma fibrinogen levels (Pϭ0.04). In the GENIC Study, the odds ratio for BI associated with CTSG Ser125 carrying was 1. Key Words: cathepsin G Ⅲ genetic polymorphism Ⅲ myocardial infarction Ⅲ brain infarction Ⅲ fibrinogen C athepsin G (CTSG) is a 26-kDa serine protease that is expressed in the promyelocyte stage of development and stored in azurophilic granules of polymorphonuclear leukocytes. 1 CTSG is released on neutrophil stimulation by platelet-activating factor, 2 tumor necrosis factor-␣, 3 and interleukin-8, 3 which then, via the CTSG platelet receptor (protease-activated receptor 4), 4 leads to calcium mobilization, secretion, and finally, platelet aggregation. Beside other metabolic effects, CTSG suppresses prostacyclin production, 5 induces the release of plasminogen activator inhibitor-1, 6 and cleaves the glycoprotein (GP) Ib ␣ subunit of the GP Ib/IX receptor complex, 7 thus promoting intravascular thrombosis. These observations have led to the suggestion that CTSG may play a role in cardiovascular and cerebrovascular pathophysiology.The CTSG gene has been localized to chromosome 14q11.2, spans 2.7 kb, and, like other serine proteases, consists of 5 exon...