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Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19 000 men in the Whitehall study 

Results At entry, 42% of the men were current smokers, 39% had high blood pressure, and 51% had high cholesterol. At the re-examination, about two thirds of the previously "current" smokers had quit smoking shortly after entry and the mean differences in levels of those with high and low levels of blood pressure and cholesterol were attenuated by two thirds. Compared with men without any baseline risk factors, the presence of all three risk factors at entry was associated with a 10 year shorter life expectancy from age 50 (23.7 v 33.3 years). Compared with men in the lowest 5% of a risk score based on smoking, diabetes, employment grade, and continuous levels of blood pressure, cholesterol concentration, and body mass index (BMI), men in the highest 5% had a 15 year shorter life expectancy from age 50 (20.2 v 35.4 years).

Conclusion Despite substantial changes in these risk factors over time, baseline differences in risk factors were associated with 10 to 15 year shorter life expectancy from age 50. . . .

Conclusions and policy implications

Previous studies in the UK4 20 and US21 showed that about half of the reduction in coronary deaths between 1980 and 2000 could be attributable to reductions in major risk factors and about half to improvements in medical treatment of people with established vascular disease. Our results provide support for the public health policies aimed at achieving modest changes in major risk factors throughout the population to achieve improvements in life expectancy.22 We have also shown that a greater proportion of older people in the UK are surviving to very old age. Continued public health strategies to lower mean levels of the three main cardiovascular risk factors, together with more intensive medical treatment for "high risk" subgroups, including use of medication to lower blood pressure23 24 and cholesterol concentration,25 that have proved efficacy could result in further improvements in life expectancy.26

What is already known on this topic

There has been uncertainty about the limits of life expectancy and the relevance of cardiovascular risk factors for prediction of life expectancy

What this study adds

Despite substantial variability within individuals in levels of cardiovascular risk factors, the presence of three major risk factors (smoking, high blood pressure, and high cholesterol concentration) recorded on a single occasion in middle aged men was associated with a 10 year shorter life span from age 50 (23.7 v 33.3 years) compared men with none of them More extreme categorisation of these risk factors including BMI, diabetes mellitus/glucose intolerance, and employment grade was associated with a 15 year difference in life expectancy from age 50 (20.2 v 35.4 years) Continued public health strategies to lower these risk factors could result in further improvements in life expectancy

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