Association between serum alkaline phosphatase and C-reactive protein in the United States National Health and Nutrition Examination Survey 2005-2006

Clin Chem Lab Med. 2010 Feb;48(2):167-73. doi: 10.1515/CCLM.2010.052.


Background: Alkaline phosphatase (ALP) is a widely used marker for skeletal and hepatobiliary disorders, but its activity is also increased in atherosclerosis and peripheral vascular disease. It is an inflammatory marker like C-reactive protein (CRP). We therefore analyzed its relationship with CRP in the United States National Health and Nutrition Examination Survey (NHANES) 2005-2006.

Methods: The analysis included 4155 men and non-pregnant women over the age of 20 years. The relationship between log-transformed ALP and plasma CRP was analyzed using univariate and multivariate models.

Results: ALP activity was significantly correlated with age, waist circumference, body mass index, blood pressure, exercise, alcohol, triglycerides, and other liver enzymes after adjusting for age, gender and ethnicity (p<0.001). ALP was significantly associated with a higher frequency of cardiovascular disease (p=0.02), hypertension (p=0.01) hypercholesterolemia (p=0.04), and diabetes (p=0.02). Compared to the lowest quartile of ALP, the adjusted odds ratio (OR) associated with the highest quartile were 1.9 [95% confidence intervals (CI) 1.1-3.5], 1.6 (95% CI 1.0-2.5), 1.5 (95% CI 1.1-2.1) and 1.7 (95% CI 1.0-2.4) for cardiovascular disease, hypertension, hypercholesterolemia, and diabetes, respectively. In multivariate analysis, log ALP was an independent predictor of log CRP (p=1.0x10(-6)). A multivariate model that included log ALP, ethnicity, glycohemoglobin, waist circumference, albumin, apolipoprotein B, gamma-glutamyltransferase and uric acid explained 40% of the variance in log CRP.

Conclusions: ALP is a marker of cardiometabolic risk, but it needs to be tested as part of a multivariate model in prospective studies.

MeSH terms

  • Age Factors
  • Alkaline Phosphatase / blood*
  • Blood Pressure
  • Body Weights and Measures
  • C-Reactive Protein / metabolism*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / metabolism
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / ethnology
  • Diabetes Mellitus / metabolism
  • Female
  • Health Surveys*
  • Humans
  • Hypercholesterolemia / epidemiology
  • Hypercholesterolemia / ethnology
  • Hypercholesterolemia / metabolism
  • Hypertension / epidemiology
  • Lipids / blood
  • Liver / enzymology
  • Male
  • Multivariate Analysis
  • Nutrition Surveys*
  • Prospective Studies
  • Risk Factors
  • Sex Factors
  • United States / epidemiology


  • Lipids
  • C-Reactive Protein
  • Alkaline Phosphatase