Lipoprotein-associated phospholipase A2 (Lp-PLA2, also known as platelet activating factor acetyl-hydrolase), is a relatively recent marker that has emerged as a major, independent predictor of CHD. Lp-PLA2 is an active phospholipase that circulates in plasma bound to LDL, and it appears to act almost exclusively on oxidized LDL to generate lysophosphatidyl-choline, which is proinflammatory and is considered to be atherogenic. Thus, Lp-PLA2 represents an interesting link between lipoproteinoxidation and vascular inflammation, which likely explain its strong, independent association with CHD risk. Data from the recent ARIC study have indicated that the predictive power of Lp-PLA2 is attenuated after adjustment for multiple established risk factors.