PreventionAbstractObjective: Secretory phospholipase A2 (sPLA2) enzyme activity is a potential inflammatorybiomarker for cardiovascular disease. We examined the tracking, or persistence, of sPLA2enzyme activity levels from childhood to adulthood, and identify potentially modifiable factorsaffecting tracking.Method: Prospective cohort of 1735 children (45% females) who had serum sPLA2 enzyme activ-ity levels and other cardiovascular disease risk factors measured in 1980 that were followed-upin 2001.Results: sPLA2 activity tracked from childhood to adulthood for males (r = 0.39) and females(r = 0.45). Those who decreased body mass index relative to their peers were more likely toresolve elevated childhood sPLA2 levels than have persistent elevated sPLA2 levels in childhood and adulthood. Those who consumed less fruit, and gained more body mass index relative totheir peers, began smoking or were a persistent smoker between childhood and adulthood weremore likely to develop incident elevated sPLA2 levels than those with persistent not elevatedsPLA2 levels.Conclusions: Childhood sPLA2 enzyme activity levels associate with adult sPLA2 levels 21 yearslater. Healthful changes in modifiable risk factors that occur between childhood and adulthoodmight prevent children from developing elevated sPLA2 levels in adulthood.© 2018 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Pediatria. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).