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Genome wide association study showed that genetic variant of sortilin was associated with the risk of coronary artery disease. However, the plasma level of sortilin and its role in atherosclerosis was not well studied. We measured plasma sortilin levels in subjects with severe coronary atherosclerosis and normal control and investigated the usefulness of plasma concentrations of sortilin in predicting atherosclerosis.Blood samples were obtained in statin-naïve subjects with severe atherosclerosis, which defined as coronary artery calcium score (CACS) was higher than 400 or a candidate for coronary artery bypass surgery (n = 34). Normal control samples were used from the subjects whose CACSs were less than 10 and without clinically relevant coronary artery disease (n = 116). Plasma sortilin was measured by ELISA (Cusabio, USA).The mean age was 64.2 ± 11.6 years in severe atherosclerosis group and 53.0 ± 9.0 years in normal control group (P < 0.001), and more male subjects were in the disease group. Circulating sortilin levels were higher in subjects with severe atherosclerosis group than normal control (1.75 ± 0.54 ng/ml vs 1.38 ± 0.97 ng/ml, P = 0.035), and the difference was also significant after adjustment of age, sex, body weight, glucose, and HDL cholesterol (P = 0.041). The ROC curve revealed that plasma sortilin levels could significantly distinguish between severe atherosclerosis and normal coronary artery. The area under curve was 0.711 with a 95% confidence interval of 0.625–0.798.Plasma sortilin levels were higher in subjects with severe atherosclerosis compared to normal control. Furthermore, the measurement of plasma sortilin levels could be a useful biomarker to predict severe atherosclerosis.