Risk factors and coronary heart disease--facts or fancy?

The importance of the many well-published epidemiologic studies for the philosophy of prevention of ischemic heart disease has led to this analysis of the background design and early results of three such studies, i.e., the Framingham study, the National Pooling Project, and the Stockholm Prospective Study. Besides indicating certain flaws in the early design, it is demonstrated that the authors usually press their factual data to conclusions that are not only really valid, with some exceptions. This analysis leads to the conclusion that high blood pressure and cigarette smoking seem to be much more important for the development of ischemic heart disease than high serum lipids in the populations studied. They are, furthermore, selected in such a way that the results cannot have any bearing on the general population and, in particular, on its lower and higher social strata.