Objectives-The chemokines monocyte chemoattractant protein-1 (MCP-1/CCL2), interleukin-8 (IL-8/CXCL8), and interferon-␥-inducible protein-10 (IP-10/CXCL10) have been reported to be involved in the development of atherosclerosis and type 2 diabetes. The aim of this study was to assess whether elevated systemic levels of these chemokines precede coronary events. Methods and Results-We investigated MCP-1, IL-8, and IP-10 serum levels in a case-cohort design based on data from 381 individuals (294 men, 87 women) with and 1977 individuals (1006 men, 971 women) without incident coronary heart disease (CHD) from the prospective, population-based MONICA/KORA Augsburg study (1984 to 2002). The mean follow-up time was 11.0 years. Baseline concentrations were significantly higher in cases compared with noncases (PՅ0.001 for all chemokines). MCP-1 and IL-8 remained associated with CHD risk after adjustment for age, sex, and survey with hazard ratios (95% confidence intervals) comparing extreme tertiles of 1.39 (1.05 to 1.84) for MCP-1 and 1.48 (1.10 to 1.99) for IL-8. However, adjustment for further cardiovascular and immunologic risk factors attenuated the observed associations, and they became nonsignificant. Conclusions-Elevated systemic levels of the chemokines MCP-1, IL-8, and IP-10 precede CHD but do not represent independent risk factors. Thus, the associations are less pronounced than previously shown for type 2 diabetes. Key Words: chemokines Ⅲ inflammation Ⅲ coronary heart disease Ⅲ case-cohort study Ⅲ prognosis I nflammatory mechanisms play an important role in the initiation and progression of cardiovascular diseases. 1 Key mediators in these processes are chemokines, a family of low-molecular-weight proteins regulating cell migration to sites of inflammation and triggering activation of many cell types. 2 They have chemotactic properties, and the repertoire of chemokine receptors on the cell surface determines the migration behavior of leukocytes and other cells. Chemokines like monocyte chemoattractant protein-1 (MCP-1/CCL2), interleukin-8 (IL-8/CXCL8), and INF-␥-inducible protein-10 (IP-10/CXCL10) are expressed in atherosclerotic lesions. [3][4][5] Their release by endothelial cells, smooth muscle cells, macrophages, and perivascular adipose tissue has been shown to mediate leukocyte adhesion to endothelial cells as well as infiltration into the arterial wall 6 and presumably also into epicardial fat, with implications for the development of coronary heart disease (CHD). 7,8 There is further evidence from preclinical and clinical studies for a contribution of chemokines to CHD. On the genetic level, deletion of MCP-1/CCL2 or its receptor CCR2 strongly attenuate macrophage recruitment and lesion formation in atherosclerosis-prone mice. 9,10 In humans, gene variants of MCP-1 and CCR2 have also been reported to increase the susceptibility to CHD in some, 11,12 but not all, studies. 13 Cross-sectional studies investigating circulating chemokine levels suggest that these processes might also be reflected on the ...