Background : Attenuated heart rate recovery (HRR) after exercise as an impaired of parasympathetic activity is associated with an increased in risk of cardiovascular mortality, but the underlying mechanisms remain unclearly understood. Inflammation plays an important role in the development of cardiovascular disease. We, therefore, examined the hypothesis that the decreased HRR may reflect the higher inflammatory status. Methods : In cross-sectional study involving 10263 middle-aged adults (mean 49.4짹8.8 years; 91% of men)) who participated in the health examination program. We evaluated the association between the markers of inflammation such high-sensitivity C-reactive protein (CRP), white blood cell (WBC), and fibrinogen and 1 minute HRR after exercise (peak heart rate minus 1-minute heart rate of recovery). Results : The study subjects showed low levels of inflammation (median CRP; 0.07mg/dl, interquartile range 0.04-0.15) with mean HRR of 25.2짹8.6bpm. The univariate regression analysis showed that HRR was significantly associated with CRP (r=-20, p<0.001), WBC (r=-0.19, p<0.001), and fibrinogen (r=-0.13, p<0.001). When the effects of age, body mass index (BMI), % body fat, glucose and VO2peak were controlled, HRR were associated with CRP (r=-0.14, p<0.001), WBC (r=-0.15, p<0.001), and fibrinogen (r=-0.11, p<0.001). By stepwise multiple regression, CRP was significantly associated with BMI, age and HRR (all of them, p<0.001). When grouped into quartiles according to increasing HRR, the highest quartiles showed decreased levels of CRP, WBC, and fibrinogen than in the lowest quartiles of HRR (each p<0.001). Conclusions : These data suggest that attenuated of HRR as decreased of parasympathetic activity showed adverse effects on inflammatory markers, which could contribute to higher incidence of cardiovascular diseases.