Aims: We aimed to evaluate the association of lipoprotein- associated phospholipase A2(Lp- PLA2) with coronary artery disease(CAD) risk factors, with the severity of angiographic CAD, and with the incidence of major adverse events. Methods and results: We measured Lp- PLA2 levels in 504 consecutive patients undergoing clinically indicated coronary angiography. Mean age was 60± 11 years and 38% were women. The mean(± SD) Lp- PLA2 level(ng/mL) was 245± 91. Lp- PLA2 levels correlated with male gender, LDL, HDL, and total cholesterol, fibrinogen, and creatinine. Lp- PLA2 levels correlated with the extent of angiographic CAD on univariate but not on multivariable analysis. During a median follow- up of 4.0 years, 72 major adverse events occurred in 61 of 466(13% ) contacted patients(20 deaths, 14 myocardial infarctions, 28 coronary revascularizations, and 10 strokes). Higher Lp- PLA2 levels were associated with a greater risk of events: the hazard ratio per SD was 1.28(95% CI 1.06- 1.54, P=0.009), and remained significant after adjusting for clinical and lipid variables and C- reactive protein. Conclusion: Higher Lp- PLA2 levels were associated with a higher incidence of major adverse events at follow- up, independently of traditional CAD risk factors and C- reactive protein. Aims: We aimed to evaluate the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) with coronary artery disease (CAD) risk factors, with the severity of angiographic CAD, and with the incidence of major adverse events. Methods and results: We Mean age was 60 ± 11 years and 38% were women. The mean ± SD Lp-PLA2 level was 245 ± 91. Lp- PLA2 levels were 504 ± 91. Lp- PLA2 levels were 504 ± 91. Lp- PLA2 levels in 504 consecutive patients undergoing clinically indicated coronary angiography. PLA2 levels correlated with male gender, LDL, HDL, and total cholesterol, fibrinogen, and creatinine. Lp-PLA2 levels correlated with the extent of angiographic CAD on univariate but not on multivariable analysis. During a median follow-up of 4.0 years, 72 greater Lp-PLA2 levels were associated with a greater risk of events: the hazard ratio per SD (major adverse events occurred in 61 of 466 (13%) contacted patients (20 deaths, 14 myocardial infarctions, 28 coronary revascularizations, and 10 strokes) was 1.28 (95% CI 1.06-1.54, P = 0.009), and remained significant after adjusting for clinical and lipid variables and C-reactive protein. Conclusion: Higher Lp-PLA2 levels were associated with a higher incidence of major adverse events at follow-up, independently of traditional CAD risk factors and C-reactive protein.