Low Risk-Factor Profile and Long-term Cardiovascular and Noncardiovascular Mortality and Life Expectancy

Abstract

Long-term, population-based, prospective studies have amassed extensive data on relationships of major coronary-cardiovascular risk factors—particularly serum cholesterol level, blood pressure, and cigarette smoking—with incidence of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD), to mortality from these causes and all causes and longevity.^1-7 These relationships have been well summarized as " . . . strong, continuous, graded, consistent, independent, predictive, and etiologically significant for those with and without coronary heart disease."⁷ The judgment on etiologic significance is based on the consistent results of many epidemiological studies and on concordant findings from clinical and postmortem investigations and animal experimentation. This judgment is reinforced by data from randomized controlled trials demonstrating that sustained lowering of high blood pressure or elevated serum cholesterol level produces sizable reductions in CHD-CVD incidence and in cause-specific and all-cause mortality.^7-14 These positive results have been obtained repeatedly, even though trials have been undertaken in middle-aged and older people after decades of exposure to these adverse traits. Extensive data also document that smoking cessation has similar favorable effects.^15,16