Total serum sialic acid (TSA), recently shown to be a cardiovascular risk factor, was measured in 15 patients with severe hypertriglyceridaemia (fasting triglyceride > 2.3 mmol l-1) and 15 age and sex matched normal control subjects. To test the hypothesis that serum TSA is related in some way to serum acute phase proteins we also measured five acute phase proteins, namely alpha-1-antichymotrypsin (ACT), alpha-1-acid-glycoprotein (AGP), alpha-2-macroglobulin (AMG), C-reactive protein (CRP) and haptoglobin (HAP) in both groups. Of note was the significantly elevated serum TSA in the severely hypertriglyceridaemic group as compared to normal subjects. Serum TSA being 71.9 +/- 11.7 mg dl-1 and 59.6 +/- 10.2 mg dl-1 respectively (P < 0.01 Mann-Whitney test). Serum CRP was significantly elevated in the type IV patients as compared to controls (6.4 +/- 4.5 mg l-1 vs. 3.3 +/- 1.9 mg l-1 P < 0.05 Mann Whitney test) as was serum AMG (2.1 +/- 0.89 g l-1 vs. 1.5 +/- 0.53 g l-1 P < 0.05 Mann Whitney test). There was no correlation between serum TSA and lipoprotein (a) in either the normal or severely hypertriglyceridaemic subjects. We suggest that serum TSA could in part be related to hypertriglyceridaemia and serum acute phase proteins but that its property as a cardiovascular risk factor is not related to serum lipoprotein (a) concentrations.