Why heart disease mortality is low in France: the time lag explanation

BMJ 1999;318:1471-1480 ( 29 May )

Education and debate

Why heart disease mortality is low in France: the time lag explanation

Commentary: Alcohol and other dietary factors may be important

Commentary: Intrauterine nutrition may be important

Commentary: Heterogeneity of populations should be taken into account

Authors' response

Malcolm Law, reader, Nicholas Wald, professor.

Wolfson Institute of Preventive Medicine, St Bartholomew's and The Royal London School of Medicine and Dentistry, London EC1M 6BQ

Correspondence to: Dr Law M.R.Law@mds.qmw.ac.uk

The first 150 words of the full text of this article appear below.

In France mortality from ischaemic heart disease is about a quarter of that in Britain.^1-7 The major risk factors are nomore favourable in France, and this so called "French paradox"has not been satisfactorily explained. Table 1 shows the differencein mortality from heart disease between the countries, and table2 shows the similar levels of animal fat consumption, serum totalcholesterol and high density lipoprotein cholesterol concentrations,blood pressure, and (in men) smoking. The French paradox is usuallyattributed to the higher consumption of alcohol in France, notablyof wine,^2-5 and some have suggested a specific effect of redwine. In this article we assess quantitatively the extent to whichthis and other possible explanations can account for the low rateof heart disease in France. We then consider a novel "time lag"hypothesis, which, we believe, is the main explanation for theparadox.

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Rapid Responses:

Read all Rapid Responses

African-Caribbeans offer another example of paradox, consistent with 'time-lag' and 'diet-heart': J Kennedy Cruickshank
bmj.com, 29 May 1999 [Full text]
Commentary: Lactose, sweeteners and wine may explain the "French paradox": William B Grant
bmj.com, 1 Jun 1999 [Full text]
A stillborn hypothesis: Uffe Ravnskov
bmj.com, 4 Jun 1999 [Full text]
Why heart disease mortality is low in France: Jeffrey J Segall
bmj.com, 8 Jun 1999 [Full text]
Controversial suggestion indicates wish to focus on modifiable risk factors with immediate results: David Leon
bmj.com, 9 Jun 1999 [Full text]
Re: Social attitudes and heart disease: Brian J Ford
bmj.com, 10 Jun 1999 [Full text]
Clearly, wine consumption correlates with the residual differences in mortality rate: John H Glaser
bmj.com, 30 Jun 1999 [Full text]
French Paradox -- Silicon?: Don Bradley
bmj.com, 4 Jul 1999 [Full text]
Flavonoids in wine, fruits, and vegetables may still be a factor in the French Paradox: John D Folts
bmj.com, 29 Jul 1999 [Full text]
Other explanations for the Southern Europe paradox: Jaume Marrugat
bmj.com, 3 Aug 1999 [Full text]
My God, fat comsumption started later in France?: Philippe Orlando
bmj.com, 3 May 2001 [Full text]