Background: High cholesterol, leukocytes (LEUK) and erythrocyte sedimentation rate (ESR) are associated with cardiovascular diseases.

Design: Cross sectional study of 10,000 healthy young men.

Methods: About 10,167 men were analyzed for the association of cholesterol concentrations and erythrocyte sedimentation rate with fitness (assessed by achieved physical working capacity at a heart rate of 170 beats per min = PWC170). Physical fitness was categorized as low (<2.5 W/kg; n = 2755) medium (2.5–2.8 W/kg; n = 3783) and good (>2.8 W/kg; n = 3629). Cholesterol was categorized as elevated cholesterol (>200 mg/dl) and normal cholesterol concentration (<200 mg/dl).

Results: Men with elevated cholesterol compared to men with normal cholesterol concentrations had significantly higher LEUK (6.34 ± 1.47 vs. 6.17 ± 1.44; p < 0.001) and ESR (2.86 ± 3.06 vs. 2.44 ± 2.43; p < 0.001). When stratified by physical fitness, this effect was present in men with low physical fitness (LEUK 6.48 ± 1.51 vs. 6.27 ± 1.44; p = 0.001; ESR 3.32 ± 3.78 vs. 2.72 ± 3.03, p < 0.001) and medium physical fitness (LEUK 6.38 ± 1.44 vs. 6.16 ± 1.43, p < 0.001; ESR 2.77 ± 3.04 vs. 2.40 ± 2.36, p < 0.001), but not in men with good physical fitness.

Conclusion: Cholesterol greater than 200 mg/dl was associated with elevated leukocytes and erythrocyte sedimentation rates, suggestive of a higher burden of inflammation. In young men with good physical fitness, this association was not present, indicating that physical fitness might be effective in preventing cardiovascular diseases by reducing the cholesterol mediated triggering of inflammation.