Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Seven Countries Study, 25 yr Follow-up

Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study.


JAMA. 1995 Jul 12;274(2):131-6.

Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F, et al.

National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands.

OBJECTIVE–To compare the relationship between serum total cholesterol and long-term mortality from coronary heart disease (CHD) in different cultures. DESIGN–Total cholesterol was measured at baseline (1958 through 1964) and at 5- and 10-year follow-up in 12,467 men aged 40 through 59 years in 16 cohorts located in seven countries: five European countries, the United States, and Japan. To increase statistical power six cohorts were formed, based on similarities in culture and cholesterol changes during the first 10 years of follow-up. MAIN OUTCOME MEASURES–Relative risks (RRs), estimated with Cox proportional hazards (survival) analysis, for 25-year CHD mortality for cholesterol quartiles and per 0.50-mmol/L (20-mg/dL) cholesterol increase. Adjustment was made for age, smoking, and systolic blood pressure. RESULTS–The age-standardized CHD mortality rates in the six cohorts ranged from 3% to 20%. The RRs for the highest compared with the lowest cholesterol quartile ranged from 1.5 to 2.3, except for Japan’s RR of 1.1. For a cholesterol level of around 5.45 mmol/L (210 mg/dL), CHD mortality rates varied from 4% to 5% in Japan and Mediterranean Southern Europe to about 15% in Northern Europe. However, the relative increase in CHD mortality due to a given cholesterol increase was similar in all cultures except Japan. Using a linear approximation, a 0.50-mmol/L (20-mg/dL) increase in total cholesterol corresponded to an increase in CHD mortality risk of 12%, which became an increase in mortality risk of 17% when adjusted for regression dilution bias. CONCLUSION–Across cultures, cholesterol is linearly related to CHD mortality, and the relative increase in CHD mortality rates with a given cholesterol increase is the same. The large difference in absolute CHD mortality rates at a given cholesterol level, however, indicates that other factors, such as diet, that are typical for cultures with a low CHD risk are also important with respect to primary prevention.

2 Responses to “Seven Countries Study, 25 yr Follow-up”

  1. Rebecca Hoover said

    Colin, here’s a question for you. When 40% of health care costs are the result of lifestyle choices, do doctors really have an interest in helping patients improve their lifestyles? Don’t doctors have an inherent conflict of interest here. It seems we would have a lot of unemployed health care professionals if we could talk folks into eating right. What would we have all of the idle doctors, nurses, etc. do?

    • Colin Rose said

      A very good question.

      I would say more like 90% of “health” care costs are lifestyle related and preventable.

      First of all let`s clear up the terminology. What is done by doctors and hospitals is not health care, but disease care. Doctors and hospital administrators pay their mortgages by treating diseases, not by preventing them. True health care is not done by doctors and hosptials but by garbage collectors, engineers providing clean air and water, safe housing, and safe transportation, condom manufacturers, nurses doing vaccinations, etc.

      In Quebec we are a little more rigorous with our terminology and have “assurance maladie” but in the rest of the world has “health” insurance.

      That is not to say that doctors have not been active in disease prevention. Not so long ago there were cigarette vending machines in hospitals. Except for a few doctors who smoked or were on the payrolls of tobacco companies most doctors were active in advising cessation of tobacco. Now, one could be cynical about this, too. Tobacco addiction is not good for the medical business of disease care. It shortens life substantially and the diseases it causes tend not to be chronic but rapidly fatal, like lung cancer and heart attack. Life expectancy has increased largely due to reduction in tobacco addiction.

      As tobacco addiction has decreased it has been replaced by junk food addiction or alcoholism in certain countries like Finland.

      Unlike tobacco addiction, junk food addiction is very profitable to the business of medicine. Its symptoms include elevations in numbers, like blood cholesterol, blood glucose and blood pressure that can be monitored and “treated” with expensive drugs over many years. Surgeons are happy, too. They can do many more gastric bypasses, coronary bypasses, and hip and knee replacements. Who`s to complain? Patients are happy in maintaining there addiction believing that “treatment” of its numerical symptoms will save them and doctors get rich.

      So, whatever effort doctors and hospitals might put into treating junk food addiction will negatively impact their bank accounts and the expansion of hospital bureaucratic empires. Consequently, billing schedules even in “socialized” medical systems like Canada´s are heavily weighted to treatments of the consequences of junk food addiction and not to treatment of the addiction itself.

      The cost of medical systems is killing the economies of many Western democracies. The US is now massively indebted largely due to Medicare, Medicaid and disability entitlements. The inevitable implosion of our economies has begun and can only be reversed if doctors decide to act as true professionals and treat the causes of preventable diseases and not just their symptoms. All the Crestor in the world will not save us from a nuclear explosion in the New York subway system that we couldn`t prevent because there was no money left for counter-terrorism.

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