Revised data for 1970 ICHD report

Blackburn, Henry; Chapman, Julie; Dawber, Thomas R.; Doyle, JJ; Epstein, Ferdinand; Kannel, William B.; Keys, A.; Moore, F.; Paul, Onah Otor; Stamler, Jeremiah; Taylor, H. L.

doi:10.1016/s0002-8703(77)80057-4

Cited by 12 publications

(3 citation statements)

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“…Other studies have reported similar results. As already noted, 44% of all first major coronary events in the middle-aged men of the Pooling Project cohort terminated fatally within one month, with 61 % of these deaths sudden (<3 hours) (12). This is in accord with world-wide experience.…”

supporting

confidence: 82%

“…About 44% of these events would be in quintiles I11 and IV, the other 56% in quintile V of serum cholesterol. With about 44% of these first major coronary events terminating in acute fatalities (12), excess deaths before age 65 would number about 636000, about 280000 of them in quintiles Ill and 1V. These are-it is relevant to emphasize-excess CHD events and deaths before age 65 attributable to hypercholesterolemia, i.e., events and deaths 2-802986 over and above those to be anticipated if all 25 million of these men had serum cholesterol levels under 218 mgldl.…”

mentioning

confidence: 99%

“…The encouraging data from two secondary prevention trials involving serum cholesterol control by dietary means lend support to this inference (53,70). 12. In regard to the results of trials, Werkij speaks of, "The repeated demonstration (that) manipulation of the serum cholesterol value in man does not influence the mortality rate .…”

mentioning

confidence: 99%

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The Established Relationship among Diet, Serum Cholesterol and Coronary Heart Disease

Stamler

1980

Journal of Internal Medicine

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The following is a response to an article by L. Werko in this journal (206:435, 1979)-its main assertions and major omissions:I . Werko asserts, without giving any facts, that in the incidence data of the U.S. national cooperative Pooling Project on quintiles of serum cholesterol and future CHD risk, "Only in the highest quintile is the risk appreciably higher.'' In fact, risk was higher by 18%, 96% and 139% for men in quintiles 111, IV and V, respectively, compared to quintiles I and I1 combined (98). Absolute excess risk of a first major coronary event before age 65i.e., a nonfatal myocardial infarction (MI) or an acutely fatal episode of coronary heart disease (CHD)-was 24, 104 and 161 per 1000 for men in quintiles 111, IV and V, respectively. These three quintiles had serum cholesterol levels of 2 18-240, 240-268 and 268+ mgldl. Clearly at least 40% of these men-quintiles IV and V, and not just quintile V-were at markedly increased risk, i.e., double or greater. Nor is the excess risk of quintile IIIgreater by 18 %, 24 extra chances per 1 O00 of premature major CHD-to be dismissed lightly.This experience of Pooling Project men with serum cholesterol of 218 or over, extrapolated to the U.S. male population age 40-64 in 1980, with about 25000000 men free of CHD (i.e., like the Pooling Project cohort), would mean almost 1.5 million excess major coronary events before age 65. About 44% of these events would be in quintiles I11 and IV, the other 56% in quintile V of serum cholesterol. With about 44% of these first major coronary events terminating in acute fatalities (12), excess deaths before age 65 would number about 636000, about 280000 of them in quintiles Ill and 1V. These are-it is relevant to emphasize-excess CHD events and deaths before age 65 attributable to hypercholesterolemia, i.e., events and deaths 2-802986 over and above those to be anticipated if all 25 million of these men had serum cholesterol levels under 218 mgldl. Particularly since Werko expresses concern about presumed economic consequences of dietary efforts to prevent CHD, it is relevant to note the huge costs that would accrue from these hundreds of thousands of excess events and deathsairect costs in medical care and indirect costs in losses to production, together amounting to billions of dollars.Fortunately, there have been improvements (modest to date) in the eating patterns of Americans and associated declines in population mean serum cholesterol levels, together with large-scale cessation of smoking, and major advances in the control of hypertension (42, 117,(119)(120)(121). Concomitantly. U.S. mortality rates from premature CHD have been declining steadily, e.g., by about 25% from 1968 to 1977 for men, in contrast to the rising rates in several northern European countries (e.g.. up by 16% for Swedish men age 55-64) (14, 42, 91, 117. 119-121). Hence the outlook for American men in the 1980s is less grim than would be anticipated from the experience of the Pooling Project cohort in the 1950s and.1960~.2. Werko asserts that risk of M...

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supporting

confidence: 82%

mentioning

confidence: 99%