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Lipoprotein phospholipase A2 (Lp-PLA2) is an emerging inflammatory marker with prognostic value. Aortic wall properties and wave reflections determine coronary perfusion, LV function and have an independent prognostic value. We investigated the association of Lp-PLA2 with arterial stiffness and abnormal wave reflections in CAD patients.Methods: We assessed in 70 patients with angiographically documented CAD. We measured pulse wave velocity using both the Complior (carotid to femoral-PWVc) and Arteriograph apparatus (PWVa-oscillometric method). By means of pulse wave analysis (Arteriograph apparatus) we calculated the augmentation index (AI) of the arterial wave reflection, the diastolic area (DAI%) of the aortic pulse wave and diastolic reflection area (DRA), an index of diastolic filling of coronary arteries derived by duration of diastole and area between the expected area of the diastolic pressure curve without wave reflection and the true area with wave reflection. Patients were also categorised into 2 subgroups according to the median values of the pulse wave analysis indices. The velocity time integral of the diastolic component of coronary flow of the LAD was assessed using Doppler echocardiographyResults: Increasing levels of Lp-PLA2 were related with smoking, increasing PWVc, PWVa, AI and decreasing DAI% and DRA (r=0.41, r=-0.31, r=-0.45 and r=0.38 r=0.47, respectively, p<0.05). Lp-PLA2 was higher in patients with PWVa >10 m/sec than in those with PWVa <10 m/sec (169±48 vs. 117±24 pg/ml, p=0.003), in patients with AI>34% than in those with AI <34% (144±40 vs. 115±29 pg/ml, p=0.02) in patients with DAI <45% than in those with DAI>45% (138±36 vs. 97± 40 pg/ml, p=0.015) and in patients with DRA<43 than in those with DRA>43(141±36 vs. 99± 40 pg/ml, p=0.01). Patients with PWVc>11 m/sec had also higher Lp-PLA2 those with PWVc <11 m/sec (171±49 vs. 119±26 pg/ml, p=0.003).A reduced resting coronary flow velocity time integral was related with reduced DAI% and DRA (r=0.36, r=0.40, p<0.05).Conclusions: Increasing levels of Lp-PLA2 are related to impaired aortic wall properties and abnormal wave reflections associated with impaired coronary diastolic filling. This finding suggests a potential role for Lp-PLA2 to identify CAD patients with adverse prognosis.