Tissue factor pathway inhibitor (TFPI), a protease inhibitor associated with lipoproteins in plasma and endothelial cells, can inhibit the initial reactions of the tissue factor-mediated coagulation pathway. A positive relationship between TFPI and cholesterol has been demonstrated in human plasma. To investigate this relation in more detail, in the present study we measured TFPI in the plasma of monkeys on a high-cholesterol diet. After diet treatment, cholesterol levels and TFPI activity were increased 3-and 1.5-fold, respectively. Three forms of TFPI, low-density lipoprotein (LDL)/very-low-density lipoprotein (VLDL)-associated TFPI, high-density lipoprotein (HDL)-associated TFPI, and free TFPI, were measured after gel filtration of plasma. In hypercholesterolemic monkeys, levels of TFPI activity and T he extrinsic blood coagulation pathway is triggered by the interaction between tissue factor (TF) and factor VII, which leads to activation of the precursors of the serine proteases, factor VII, factor IX, factor X, and prothrombin, resulting in the generation of thrombin. (For a review see References 1 and 2.) These reactions are regulated by several different mechanisms, eg, inactivation of cofactors by activated protein C and inactivation of activated proteases by protease inhibitors such as antithrombin III. TF pathway inhibitor (TFPI), a protease inhibitor with three tandem Kunitz-type inhibitory domains, inhibits factor Vila and factor Xa in the presence of TF, so that TFPI is an inhibitor of the initial reaction of the extrinsic pathway. (For reviews see References 3 through 7.)The most striking characteristics of TFPI are its association with lipoproteins in plasma and endothelial cells. It has been demonstrated that three forms of TFPI, low-density lipoprotein (LDL)/very-low-density lipoprotein (VLDL)-associated TFPI, high-density lipoprotein (HDL)-associated TFPI, and the free form of TFPI, can be detected by gel filtration of human plasma; it has also been shown that heparin infusion markedly increases the free form of TFPI, which is thought to be derived from