What are the four main causes of elevated hs-CRP in otherwise healthy men?

The four reversible drivers of elevated hs-CRP in men who appear otherwise healthy, ranked by population prevalence in American men over 40, are: visceral fat, obstructive sleep apnea, periodontal disease, and insulin resistance. These four account for the large majority of "elevated hs-CRP with no obvious cause" seen in primary care practices.

Visceral adipose tissue (the fat stored around the abdominal organs) secretes pro-inflammatory cytokines, including IL-6 and TNF-alpha, directly into the portal circulation, driving continuous hepatic CRP production. Sleep apnea produces nightly hypoxic stress that activates the NF-kB inflammatory pathway with the reliability of a nightly dose. Periodontal disease drives chronic bacteremia, oral pathogens entering the bloodstream through inflamed gum tissue, that triggers systemic immune activation. Insulin resistance, even in the pre-diabetic subclinical stage, generates inflammatory signaling through advanced glycation end-products and oxidative stress pathways. Each one is identifiable. Each one is reducible. Finding which combination you are carrying is the specific output of an elevated hs-CRP result. (Buckley et al., European Heart Journal, 2009)

Cardiologist's calibrated position, Solid (1) for visceral fat and sleep apnea as the primary drivers. Promising (2) for periodontal disease (association strong, intervention RCT data still emerging). Solid (1) for insulin resistance.

What to do: Before pursuing anti-inflammatory supplements or requesting a statin, systematically assess all four drivers. Treating hs-CRP pharmacologically while a treatable driver operates unchanged is managing a symptom while leaving the cause.

For the full picture, read Inflammation's Invoice.