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Why mortality from heart disease is low in France

BMJ 2000; 320 doi: (Published 22 January 2000) Cite this as: BMJ 2000;320:249

Rates of coronary events are similar in France and southern Europe

  1. Pierre Ducimetière, research director (,
  2. Thierry Lang, epidemiologist,
  3. Philippe Amouyel, professor,
  4. Dominique Arveiler, epidemiologist,
  5. Jean Ferrières, epidemiologist
  1. INSERM U258, Cardiovascular and Metabolic Epidemiology, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807 Villejuif cedex, France
  2. NSERM U508, Epidemiology of Chronic Diseases, Institut Pasteur de Lille, 1 rue du Professeur Calmette, 59019 Lille cedex
  3. Laboratory of Epidemiology and Public Health, Faculty of Medicine, 11 rue Humann, 67085 Strasbourg cedex, France
  4. INSERM U518, Department of Epidemiology, Faculty of Medicine, 37 Allèe J Guesde, 31073 Toulouse cedex, France
  5. Unitat de Lipids i Epidemiologia Cardiovascular, Institut Municipal d'lnvestigació Medica, Carrer Dr Aiguader, 80, E-08003 Barcelona, Spain
  6. 4 Woodpark Circle, Lexington, MA 02421, USA

    EDITOR—Law and Wald focused on the so called French paradox.1 In the 1980s national statistics and data on food balance were the only available sources of information, and the eccentric position of France on a plot of mortality from coronary heart disease against consumption of animal fat was obvious.2 3 However, we later concluded that caution was necessary because data on comparative incidence were unavailable and interpretation should not rely entirely on the dietary lipids and heart disease hypothesis, although it may be central.4

    Using mortality as a surrogate for incidence may be misleading. Data from the MONICA project are now available,5 and the content of Law and Wald's article might have been considerably different had they written it a few months later. During 1985-95 rates of coronary events per 100 000 men aged 35-64 averaged 274 in three French regions, 266 in two Italian regions, 261 in two Swiss regions, 210 in Barcelona, 695 in Belfast, and 777 in Glasgow. Rates …

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