BACKGROUND Although numerous studies have demonstrated a positive association of high-sensitivity C-reactive protein (CRP) with the incidence of coronary heart disease (CHD), little information exists regarding this issue in Japanese. METHODS AND RESULTS The association between CRP and the Framingham Risk Score (FRS) was investigated in 2,523 middle-aged Japanese men without a medical history of CHD. CRP was significantly associated with this score obtained from all FRS factors. After dividing subjects into 4 categories of relative risk estimate for CHD, the geometric mean of CRP (mg/L) increased gradually with the CHD risk (below average: 0.39 [95% confidence interval, 0.37-0.41], average: 0.58 [0.50-0.67], moderately above average: 0.70 [0.57-0.86], high: 0.79 [0.58-1.09], trend p<0.001). However, it should be noted that the mean CRP concentration of the high-risk group was only 0.79 mg/L and a greater proportion (63.8%) of the high-risk subjects was in the low-risk range of CRP (<1 mg/L). CONCLUSIONS Circulating CRP well reflect the estimated CHD risk, indicating that CRP may be useful for coronary risk stratification in Japanese also. However, the details of the CRP level in Japanese must be investigated further by prospective studies to determine the Japanese-specific cutoff points for CHD risk evaluation.