Furthermore, it has been reported that inflammatory cytokine induction of ENPP2 is suppressed by 50% in primary human monocyte-derived macrophages that carry the Chr9p21 risk haplotype allele.46 The contribution of ATX to CHD is not understood and may vary with underlying genetic cause.47 Indeed, while it metabolizes lysoPL to lysoPA in health, in acute coronary syndromes other pathways appear to predominate.18 This mirrors our suggestion that ATX might be less involved in plasmas with elevated CVD risk, with other uncharacterized pathways being relevant. This evidence concerns the gene ENPP2 and coronary artery disorder.