This study investigated the relationship between serum sialic acid concentration and cardiovascular mortality. Correlations were determined between lifestyle-related coronary heart disease risk markers (cigarette consumption, alcohol consumption, and leisure time physical activity), biological risk markers (apolipoprotein A1, apolipoprotein B, lipoprotein(a), and diastolic blood pressure) on the one hand and the concentration of sialic acid as well as sialic acid-rich acute phase proteins (orosomucoid, haptoglobin, and alpha 1-antitrypsin) on the other. A total of 145 men aged 21-46 years and with a C-reactive protein concentration below 5 mg/l were included. Total sialic acid concentration correlated significantly with apolipoprotein B (r = 0.48), number of cigarettes smoked daily (r = 0.32), and leisure time physical activity (r = -0.23) after adjustment for age and other cardiovascular risk markers. No significant partial correlations were found between serum total sialic acid concentration on the one hand and alcohol consumption, apolipoprotein A1, lipoprotein(a), and diastolic blood pressure on the other. Of the sialic acid-rich glycoproteins, orosomucoid correlated with apolipoprotein B (r = 0.38), haptoglobin with cigarette consumption (r = 0.35) and leisure time physical activity (r = -0.26) and alpha 1-antitrypsin with cigarette consumption (r = 0.18), leisure time physical activity (r = 0.17), alcohol consumption (r = -0.18), and apolipoprotein B (r = 0.21) after adjustment for age and other cardiovascular risk markers.