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

In France mortality from ischaemic heart disease is about a quarter of that in Britain.1^–7 The major risk factors are no more favourable in France, and this so called “French paradox” has not been satisfactorily explained. Table 1 shows the difference in mortality from heart disease between the countries, and table 2 shows the similar levels of animal fat consumption, serum total cholesterol and high density lipoprotein cholesterol concentrations, blood pressure, and (in men) smoking. The French paradox is usually attributed to the higher consumption of alcohol in France, notably of wine,2^–5 and some have suggested a specific effect of red wine. In this article we assess quantitatively the extent to which this and other possible explanations can account for the low rate of heart disease in France. We then consider a novel “time lag” hypothesis, which, we believe, is the main explanation for the paradox.