['Visceral obesity (VO) is associated with an increased risk of cardiovascular disease. Elevated C-reactive protein (CRP) levels are associated with VO and cardiovascular disease. After exploring the relation between CRP and VO, we aimed to evaluate the VO independent relation between CRP and carotid atherosclerosis.', 'The prevalence of inflammation was evaluated in 439 male subjects with VO without type 2 diabetes and manifest cardiovascular disease. Waist circumference significantly correlated with CRP (r: 0.20, p<0.001). However, 18.2% of patients in the waist circumference group 94-102 had elevated CRP levels while 9.6% of patients in the waist circumference group >118 cm had low CRP levels. From the 439 subjects, 40 subjects were prospectively selected for MRI assessment of carotid atherosclerosis and visceral and subcutaneous adipose tissue distribution in a case-control setting matching for age and waist circumference. Twenty male subjects with age >50 years with CRP levels >2.5mg/L (CRP+) were compared to 20 controls with CRP levels <1.8 mg/L (CRP-). Maximum vessel wall thickness in CRP+ was significantly higher both in the common carotid artery (15%, p<0.01) and the bulb region (18%, p<0.01). The distribution of fat in visceral and subcutaneous deposits was not significantly different between CRP+ and CRP-.'] Are elevated CRP levels associated with increased carotid atherosclerosis independent of visceral obesity?