Does the predictive value of baseline coronary risk factors change over a 30-year follow-up?

The association of baseline serum total cholesterol, systolic blood pressure, smoking and body mass index with coronary heart disease (CHD) mortality was analyzed among 1,619 men aged 40-59 at baseline. Analyses were made separately for the first, second and third decade of follow-up. Serum cholesterol and smoking more than 9 cigarettes daily were strong predictors of risk of CHD death (n = 450) occurring early and late during the 30-year follow-up. After 20 years of follow-up, systolic blood pressure was no longer associated with CHD risk. In contrast, highest tertile of body mass index (over 24.7 kg/m2) was only then associated with increased CHD risk. The correlations between the baseline and the 30-year risk factor values were 0.42 for serum cholesterol (n = 444), 0.28 for systolic blood pressure (n = 444) and 0.57 for body mass index (n = 429). Our results showed large differences in the long-term predictive power of the classical coronary risk factors. The reasons for these differences are discussed.