BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVDs) represent a global health burden contributing to substantial morbidity and mortality. The neutrophil gelatinase-associated lipocalin (NGAL), a small glycoprotein, is secreted by inflammatory neutrophils, macrophages, and dendritic cells, playing a role in inflammation. However, its relevance as a predictor of ASCVDs risk across patients from low to very high-risk, and correlation with the need for revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) remains largely unexplored. Our objective was to assess plasma NGAl levels in patients with low to very high risk of ASCVD and their relationship with the severity of CAD and the requirement for revascularization. METHODS: Outpatients and patients undergoing catheterization were categorized into low, moderate, high, and very high risk of ASCVD. Plasma levels of NGAL were measured using ELISA and analyzed in relation to CAD status and the need for revascularization by PCI or CABG. RESULTS: Plasma NGAl levels were elevated in CAD patients, with higher levels in patients with acute coronary syndrome compared to those with stable angina. A gradual increase in plasma NGAl levels was noted with the elevated risk of ASCVD and degree of coronary artery stenosis. Notably, plasma NGAl level was independently correlated with ASCVD risk and the need for revascularization by PCI. CONCLUSION: Our study indicates that plasma NGAl levels are linked to the risk of ASCVD and may help predict the development and severity of CAD. Further research targeting NGAL could explore its potential to mitigate the risk of ASCVD.