Background Both high-sensitivity C-reactive protein (hsCRP) and electron beam computed tomography (EBCT) core nary artery calcification (CAC) ore valid markers of cardiovascular risk. it is unknown whether hsCRP is a marker of atherosclerotic burden or whether it reflects a process leg, inflammatory fibrous cap degradation) leading to acute coronary events. Methods A nested case-control study was performed of 188 men enrolled in the Prospective Army Coronary Calcium study. The serum hsCRP revels (latex agglutination assay) were evaluated in subjects with CAC (CAC score >0, n = 94) and compared with age- and smoking status-matched control subjects (CAC score >0, n = 94). Results Levels of hsCRP in the highest quartile were related to the following coronary risk factors: smoking status, low-density lipoprotein cholesterol, body mosi index, glycosylated hemoglobin, fibrinogen, and homocysteine. The mean hsCRP level was similar in cases (+CAC, 0.20 +/- 0.22 mg/dL) and controls (-CAC, 0.19 +/- 0.21 mg/dl; P = .81) and was unrelated to the log-transformed CAC score (r < 0.01, P = .91). Multivariable analysis controlling for standard risk factors, aspirin, and statin therapy found only that low-density lipoprotein cholesterol was related to CAC. Conclusions Despite associations with standard and emerging cardiovascular risk factors, hsCRP is unrelated to the presence and extent of calcified subclinical atherosclerosis. Thin implies that CAC to disease marker) and hsCRP (a process marker) may be complementary for the prediction of cardiovascular risk.