Cardiovascular disease (CVD) is the leading cause of death worldwide. New therapeutic strategies are aimed to modulate the athero-inflammatory process that partially orchestrates underlying vascular damage. Peripheral blood circulating cells (PBCCs) include different immune cells with a central role in the development of the atherogenic inflammatory response. The anti-aging factor α-Klotho (KL) has been related to protective effects against CVD. KL is expressed in monocytes, macrophages and lymphocytes where it exerts anti-inflammatory effects. Our aim is to characterize the relationships between inflammatory markers and KL gene expression in PBCCs or serum levels of soluble KL (sKL) in atherosclerotic vascular disease. For this, we conducted a cross-sectional single center case-control study including 76 CVD patients and a control group of 16 cadaveric organ donors without medical antecedent or study indicating CVD. Vascular artery fragments, whole blood and serum samples were obtained during elective or organ retrieval surgery, respectively. Serum levels of sKL, TNFα and IL10 were measured. Gene expression levels of KL, TNF, IL10, NFKB1, DNMT1, and DNMT3A, and KL promoter methylation percentage in PBCCs were also determined. Histological and immunohistochemical analyses were employed to visualize atherosclerotic lesions and to measure IL10 and TNFα levels in vascular fragments.CVD patients presented higher values for pro-inflammatory markers in the vasculature, PBCCs and systemically compared to controls. In PBCCs, CVD group presented lower expression of KL gene compared to controls (56.4% reduction, P<0.001), which was accompanied by higher methylation of its promoter (34.1±4.1% vs. 14.6±3.4%, P<0.01) and higher gene expression of DNMT1 and DNMT3A (P<0.0001 for both). KL expression correlated inversely with pro-inflammatory markers in PBCCs and vasculature, but directly with anti-inflammatory markers. sKL serum levels presented similar associations with pro- and anti-inflammatory markers in PBCCs. KL expression in PBCCs and serum sKL levels were diminished in patients with macroscopically observable atheromatous plaques.We conclude that KL gene downregulation in PBCCs during atherosclerotic vascular disease, which is mediated by promoter methylation, is associated with the pro-inflammatory status developed in this disorder either in the vasculature or systemically.