Objective:To determine the association of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) measured in the acute period and the short-term risk of recurrent vascular events in patients with TIA or minor stroke.Methods:We measured Lp-PLA(2) activity (Lp-PLA(2)-A) in a subset of 3,201 participants enrolled in the CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) trial. Participants with TIA or minor stroke were enrolled within 24 hours of symptom onset and randomized to single or dual antiplatelet therapy. In the current analysis, the primary outcome was defined as the composite of ischemic stroke, myocardial infarction, or death within 90 days.Results:The composite endpoint occurred in 299 of 3,021 participants (9.9%). The population average Lp-PLA(2)-A level was 209 59 nmol/min/mL (95% confidence interval [CI] 207-211). Older age, male sex, and current smoking were associated with higher Lp-PLA(2)-A levels. Lp-PLA(2)-A was significantly associated with the primary endpoint (adjusted hazard ratio 1.07, 95% CI 1.01-1.13 for every 30 nmol/min/mL increase). Similar results were seen for ischemic stroke alone. Adjustment for low-density lipoprotein cholesterol attenuated the association between Lp-PLA(2)-A and the primary endpoint (adjusted hazard ratio 1.04, 95% CI 0.97-1.11 for every 30 nmol/min/mL increase).Conclusions:Higher levels of Lp-PLA(2)-A in the acute period are associated with increased short-term risk of recurrent vascular events.