BACKGROUND Epidemiologic studies have shown that serum total bilirubin is inversely related to an increased risk of coronary artery disease. However, the number of studies which have focused on the relationship between bilirubin and C-reactive protein (CRP), which is a marker reflecting chronic vascular inflammation, are limited. METHODS This cross-sectional study consisted of 2307 Korean adults who visited the Center for Health Promotion for a routine health check-up from January 2009 to December 2009. RESULTS CRP level showed a declining tendency as total bilirubin increased according to total bilirubin quartiles. Negative relations of CRP with both total and direct bilirubin were found after adjustment of age, body mass index, hypertension, diabetes, hypercholesterolemia, cardiovascular disease, taking aspirin, smoking, alcohol drinking and regular exercise and total bilirubin or direct bilirubin. CONCLUSIONS This study found that elevation of the two types of bilirubin (total and direct) have a relationship with a low serum CRP level among apparently healthy Korean adults. It is hypothesized that a low serum CRP level may be due to the antioxidant and anti-inflammatory effects of bilirubin metabolism.